title: Managing a nosocomial outbreak of carbapenem-resistant Klebsiella pneumoniae: an early Australian hospital experience.
abstract: BACKGROUND
  Carbapenems are traditionally reserved as the last line of defence for treatment of serious infections with multiresistant Gram-negative bacilli. Reports of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms have been emerging globally, but rare in Australasia to date. We describe an outbreak of KPC-2 producing K. pneumoniae at an Australian hospital.
  
  
  METHODS
  After initial detection in October 2012, a retrospective review of patients with meropenem-resistant K. pneumoniae to June 2012, and ongoing prospective surveillance, was undertaken. Included patients were admitted to the hospital after June 2012 and had meropenem-resistant K. pneumoniae isolated from any site. Available isolates underwent detection of the KPC-2 gene by polymerase chain reaction and molecular typing was performed to determine genetic relatedness between isolates. Point-prevalence screening was performed on selected wards to detect asymptomatic carriage. Infection control procedures were implemented to contain the outbreak.
  
  
  RESULTS
  Ten cases were identified in the initial cluster. Eight were localised to a single inpatient ward. Point-prevalence screening revealed one extra case. After temporary containment, re-emergence of KPC-producing isolates was observed post October 2013 with 18 further cases identified. Four K. pneumoniae isolates in the 2012 cluster and 16 from the 2013-2014 cluster were referred for further testing. All carried the KPC-2 beta-lactamase gene. The 2012 isolates were genetically similar to the 2014 isolates.
  
  
  CONCLUSIONS
  KPC-2 mediated resistance is an emerging threat in Australia. The re-emergence of KPC despite initial containment emphasises the need for constant vigilance in the microbiology laboratory and ongoing maintenance of infection control and antimicrobial stewardship activity.
authors.affiliation: Department of Microbiology, Dorevitch Pathology, Melbourne, Victoria, Australia.
authors.forename: L W K
authors.initials: LW
authors.lastname: Chang
authors.affiliation: Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia.|Infectious Diseases Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: K L
authors.initials: KL
authors.lastname: Buising
authors.affiliation: Infectious Diseases Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: C J
authors.initials: CJ
authors.lastname: Jeremiah
authors.affiliation: Department of Microbiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: K
authors.initials: K
authors.lastname: Cronin
authors.affiliation: Pharmacy Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Y S
authors.initials: YS
authors.lastname: Poy Lorenzo
authors.affiliation: Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors.forename: B P
authors.initials: BP
authors.lastname: Howden
authors.affiliation: Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne, at The Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Kwong
authors.affiliation: Infection Prevention and Control Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Cocks
authors.affiliation: Infection Prevention and Control Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Blood
authors.affiliation: Infection Prevention and Control Unit, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Greenough
authors.affiliation: Department of Microbiology, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: M J
authors.initials: MJ
authors.lastname: Waters
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001315:Australia / Q000453:epidemiology; D015780:Carbapenems / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy*; D004196:Disease Outbreaks; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D017053:Infection Control; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; C491478:beta-lactamase KPC-2; D001618:beta-Lactamases
keywords: KPC; Klebsiella pneumoniae; antimicrobial resistance; carbapenemase