title: Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida.
abstract: OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase-producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase-3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak. Infect Control Hosp Epidemiol 2017;38:320-326.
authors.affiliation: 1Jackson Memorial Hospital,Miami,Florida.
authors.forename: Adriana
authors.initials: A
authors.lastname: Jiménez
authors.affiliation: 3University of Miami Miller School of Medicine,Miami,Florida.
authors.forename: José G
authors.initials: JG
authors.lastname: Castro
authors.affiliation: 4Froedtert Hospital and the Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: L Silvia
authors.initials: LS
authors.lastname: Munoz-Price
authors.affiliation: 1Jackson Memorial Hospital,Miami,Florida.
authors.forename: Dennise
authors.initials: D
authors.lastname: de Pascale
authors.affiliation: 5Cleveland Clinic,Cleveland,Ohio.
authors.forename: Luis
authors.initials: L
authors.lastname: Shimose
authors.affiliation: 6University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Mustapha M
authors.initials: MM
authors.lastname: Mustapha
authors.affiliation: 6University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Caressa N
authors.initials: CN
authors.lastname: Spychala
authors.affiliation: 6University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Roberta T
authors.initials: RT
authors.lastname: Mettus
authors.affiliation: 6University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Vaughn S
authors.initials: VS
authors.lastname: Cooper
authors.affiliation: 6University of Pittsburgh School of Medicine,Pittsburgh,Pennsylvania.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis; D016971:Citrobacter freundii / Q000201:enzymology / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology; D004196:Disease Outbreaks; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D005260:Female; D005431:Florida; D006801:Humans; D017053:Infection Control / Q000379:methods; D007362:Intensive Care Units / Q000592:standards; D007711:Klebsiella pneumoniae / Q000201:enzymology*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D062606:Tertiary Care Centers; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase