title: Persisting transmission of carbapenemase-producing Klebsiella pneumoniae due to an environmental reservoir in a university hospital, France, 2012 to 2014.
abstract: In France, the proportion of episodes of carbapenemase-producing Enterobacteriaceae (CPE) with no recent stay or hospitalisation abroad is increasing. In this study, we investigate epidemiological links between apparently unrelated cases of OXA-48-producing Klebsiella pneumoniae (Kp OXA-48) colonisation or infection. We genotyped detected organisms by repetitive sequence-based PCR, and used a dynamic registry of cases and contacts to cross-reference patients' hospital stays. Between 1 November 2012 and 28 February 2014, 23 Kp OXA-48 cases were detected in a university hospital in Montpellier, of which 15 were involved in three outbreaks: outbreaks I and II occurred in November 2012 and outbreak III in October 2013. Molecular comparison of bacterial strains revealed clonal identity between cases involved in outbreaks II and III and four single cases. Cross-referencing of hospital stays revealed that these single cases and the index case of outbreak III had occupied the same room. Active case search among former occupants of that room found an additional Kp OXA-48 carrier. A clonal strain was isolated from the sink of that room. The epidemiological link between the contaminated room and outbreak II remained undetected. This study is a reminder that environmental reservoirs should be considered as a source of CPE transmission.
authors.affiliation: Department of Infection Control and Prevention, University Hospital of Montpellier, France.
authors.forename: Béatrice
authors.initials: B
authors.lastname: Clarivet
authors.forename: Delphine
authors.initials: D
authors.lastname: Grau
authors.forename: Estelle
authors.initials: E
authors.lastname: Jumas-Bilak
authors.forename: Hélène
authors.initials: H
authors.lastname: Jean-Pierre
authors.forename: Alix
authors.initials: A
authors.lastname: Pantel
authors.forename: Sylvie
authors.initials: S
authors.lastname: Parer
authors.forename: Anne
authors.initials: A
authors.lastname: Lotthé
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000096:biosynthesis / Q000378:metabolism; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D004197:Disease Reservoirs / Q000382:microbiology / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University / Q000706:statistics & numerical data*; D006801:Humans; D007709:Klebsiella / Q000378:metabolism; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis / Q000378:metabolism
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Hygiene; carbapenemase-producing Enterobacteriaceae; environmental reservoir; healthcare-associated infections; outbreaks