title: Instant Typing Is Essential to Detect Transmission of Extended-Spectrum Beta-Lactamase-Producing Klebsiella Species.
abstract: BACKGROUND
  Infections with multidrug-resistant (MDR) microorganisms are an increasing threat to hospitalized patients. Although rapid typing of MDR microorganisms is required to apply targeted prevention measures, technical barriers often prevent this. We aimed to assess whether extended-spectrum beta-lactamase (ESBL)-producing Klebsiella species are transmitted between patients and whether routine, rapid typing is needed.
  
  
  METHODS
  For 43 months, the clonality of all ESBL-producing Klebsiella isolates from patients admitted to Erasmus MC University Medical Center in Rotterdam, the Netherlands was assessed with Raman spectroscopy. A cluster was defined as n ≥ 2 patients who had identical isolates. Primary patients were the first patients in each cluster. Secondary patients were those identified with an isolate clonally related to the isolate of the primary patient.
  
  
  RESULTS
  Isolates from 132 patients were analyzed. We identified 17 clusters, with 17 primary and 56 secondary patients. Fifty-nine patients had a unique isolate. Patients (n = 15) in four out of the 17 clusters were epidemiologically related. Ten of these 15 patients developed an infection.
  
  
  CONCLUSIONS
  Clonal outbreaks of ESBL-producing Klebsiella species were detected in our hospital. Theoretically, after Raman spectroscopy had detected a cluster of n ≥ 2, six infections in secondary patients could have been prevented. These findings demonstrate that spread of ESBL-producing Klebsiella species occurs, even in a non-outbreak setting, and underscore the need for routine rapid typing of these MDR bacteria.
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: Anne F
authors: AF
authors: Voor in 't Holt
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: Juliëtte A
authors: JA
authors: Severin
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: Wil H F
authors: WH
authors: Goessens
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: René
authors: R
authors: Te Witt
authors: Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors: Margreet C
authors: MC
authors: Vos
mesh_terms: D001426:Bacterial Proteins / Q000096:biosynthesis*; D015373:Bacterial Typing Techniques; D003428:Cross Infection / Q000201:enzymology / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D015964:Gene Expression Regulation, Bacterial; D015971:Gene Expression Regulation, Enzymologic; D006801:Humans; D007710:Klebsiella Infections / Q000201:enzymology / Q000453:epidemiology; D041121:Klebsiella oxytoca / Q000145:classification / Q000201:enzymology / Q000302:isolation & purification; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases