title: Coincidental detection of the first outbreak of carbapenemase-producing Klebsiella pneumoniae colonisation in a primary care hospital, Finland, 2013.
abstract: In Finland, occurrence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has previously been sporadic and related to travel. We describe the first outbreak of colonisation with KPC-KP strain ST512; it affected nine patients in a 137-bed primary care hospital. The index case was detected by chance when a non-prescribed urine culture was taken from an asymptomatic patient with suprapubic urinary catheter in June 2013. Thereafter, all patients on the 38-bed ward were screened until two screening rounds were negative and extensive control measures were performed. Eight additional KPC-KP-carriers were found, and the highest prevalence of carriers on the ward was nine of 38. All other patients hospitalised on the outbreak ward between 1 May and 10 June and 101 former roommates of KPC-KP carriers since January had negative screening results. Two screening rounds on the hospital's other wards were negative. No link to travel abroad was detected. Compared with non-carriers, but without statistical significance, KPC-KP carriers were older (83 vs 76 years) and had more often received antimicrobial treatment within the three months before screening (9/9 vs 90/133). No clinical infections occurred during the six-month follow-up. Early detection, prompt control measures and repetitive screening were crucial in controlling the outbreak.
authors.affiliation: Helsinki University Central Hospital, Department of Infectious Diseases, Helsinki, Finland.
authors.forename: M
authors.initials: M
authors.lastname: Kanerva
authors.forename: K
authors.initials: K
authors.lastname: Skogberg
authors.forename: K
authors.initials: K
authors.lastname: Ryynänen
authors.forename: A
authors.initials: A
authors.lastname: Pahkamäki
authors.forename: J
authors.initials: J
authors.lastname: Jalava
authors.forename: J
authors.initials: J
authors.lastname: Ollgren
authors.forename: E
authors.initials: E
authors.lastname: Tarkka
authors.forename: O
authors.initials: O
authors.lastname: Lyytikäinen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000378:metabolism; D015373:Bacterial Typing Techniques / Q000379:methods*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005387:Finland / Q000453:epidemiology; D006744:Hospital Bed Capacity, 100 to 299; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000235:genetics* / Q000302:isolation & purification; D008297:Male; D008403:Mass Screening / Q000379:methods; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D011320:Primary Health Care; D012007:Rectum / Q000382:microbiology; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase