An outbreak of carbapenem-resistant OXA-48 – producing Klebsiella pneumonia associated to duodenoscopy

Antimicrobial Resistance and Infection Control

Axel Kola¹  Brar Piening¹  Ulrich-Frank Pape²  Wilfried Veltzke-Schlieker²  Martin Kaase³  Christine Geffers¹  Bertram Wiedenmann²  Petra Gastmeier¹ 

[1] Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany

[2] Medical Department, Division of Hepatology and Gastroenterology, Charité - University Medicine Berlin, Berlin, Germany

[3] National Reference Laboratory for multidrug-resistant Gram-negative bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany

关键词: Endoscopy;    Outbreak;    OXA-48;    Carbapenemases;    K. pneumoniae;   

Others  :  1147443
DOI  :  10.1186/s13756-015-0049-4

 received in 2014-11-14, accepted in 2015-03-13,  发布年份 2015

【 摘 要 】

Background

Carbapenemase-producing Enterobacteriaceae (CPE) have become a major problem for healthcare systems worldwide. While the first reports from European hospitals described the introduction of CPE from endemic countries, there is now a growing number of reports describing outbreaks of CPE in European hospitals. Here we report an outbreak of Carbapenem-resistant K. pneumoniae in a German University hospital which was in part associated to duodenoscopy.

Findings

Between December 6, 2012 and January 10, 2013, carbapenem-resistant K. pneumoniae (CRKP) was cultured from 12 patients staying on 4 different wards. The amplification of carbapenemase genes by multiplex PCR showed presence of the bla_OXA-48 gene. Molecular typing confirmed the identity of all 12 isolates. Reviewing the medical records of CRKP cases revealed that there was a spatial relationship between 6 of the cases which were located on the same wards. The remaining 6 cases were all related to endoscopic retrograde cholangiopancreatography (ERCP) which was performed with the same duodenoscope. The outbreak ended after the endoscope was sent to the manufacturer for maintenance.

Conclusions

Though the outbreak strain was also disseminated to patients who did not undergo ERCP and environmental sources or medical personnel also contributed to the outbreak, the gut of colonized patients is the main source for CPE. Therefore, accurate and stringent reprocessing of endoscopic instruments is extremely important, which is especially true for more complex instruments like the duodenoscope (TJF Q180V series) involved in the outbreak described here.

【 授权许可】

   
2015 Kola et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Schwaber MJ, Carmeli Y. Carbapenem-resistant Enterobacteriaceae: a potential threat. JAMA. 2008; 300:2911-2913.
• [2]Akova M, Daikos GL, Tzouvelekis L, Carmeli Y. Interventional strategies and current clinical experience with carbapenemase-producing Gram-negative bacteria. Clin Microbiol Infect. 2012; 18:439-448.
• [3]Carbonne A, Thiolet JM, Fournier S, Fortineau N, Kassis-Chikhani N, Boytchev I, et al: Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009. Euro Surveill. 2010; 15:pii: 19734.
• [4]Alrabaa SF, Nguyen P, Sanderson R, Baluch A, Sandin RL, Kelker D et al.. Early identification and control of carbapenemase-producing Klebsiella pneumoniae, originating from contaminated endoscopic equipment. Am J Infect Control. 2013; 41:562-564.
• [5]Naas T, Cuzon G, Babics A, Fortineau N, Boytchev I, Gayral F et al.. Endoscopy-associated transmission of carbapenem-resistant Klebsiella pneumoniae producing KPC-2 beta-lactamase. J Antimicrob Chemother. 2010; 65:1305-1306.
• [6]Notes from the field: New Delhi metallo-beta-lactamase-producing Escherichia coli associated with endoscopic retrograde cholangiopancreatography - Illinois, 2013. MMWR Morb Mortal Wkly Rep. 2014; 62:1051.
• [7]Epstein L, Hunter JC, Arwady MA, Tsai V, Stein L, Gribogiannis M et al.. New Delhi metallo-beta-lactamase-producing carbapenem-resistant Escherichia coli associated with exposure to duodenoscopes. JAMA. 2014; 312:1447-1455.
• [8]Poirel L, Walsh TR, Cuvillier V, Nordmann P. Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis. 2011; 70:119-123.
• [9]Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH et al.. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995; 33:2233-2239.
• [10]Hygiene requirements for the reprocessing of medical devices. Recommendation of the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012; 55:1244-1310.
• [11]Aumeran C, Poincloux L, Souweine B, Robin F, Laurichesse H, Baud O et al.. Multidrug-resistant Klebsiella pneumoniae outbreak after endoscopic retrograde cholangiopancreatography. Endoscopy. 2010; 42:895-899.
• [12]Kovaleva J, Peters FT, van der Mei HC, Degener JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013; 26:231-254.
• [13]Muscarella LF. Risk of transmission of carbapenem-resistant Enterobacteriaceae and related “superbugs” during gastrointestinal endoscopy. World J Gastrointest Endosc. 2014; 6:457-474.
• [14]Design of Endoscopic Retrograde Cholangiopancreatography (ERCP). Duodenoscopes may impede effective cleaning: FDA safety communication, issued February 19, 2015. http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm434871.htm.