OBJECTIVE: To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)-producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission. DESIGN, SETTING, AND PATIENTS: Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital. METHODS: Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations. RESULTS: Two patients were initially identified with NDM-producing CRE during July-August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission. CONCLUSIONS: A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.
OBJECTIVE: To investigate an outbreak of New Delhi metallo-β-lactamase (NDM)-producing carbapenem-resistant Enterobacteriaceae (CRE) and determine interventions to interrupt transmission. DESIGN, SETTING, AND PATIENTS: Epidemiologic investigation of an outbreak of NDM-producing CRE among patients at a Colorado acute care hospital. METHODS: Case patients had NDM-producing CRE isolated from clinical or rectal surveillance cultures (SCs) collected during the period January 1, 2012, through October 20, 2012. Case patients were identified through microbiology records and 6 rounds of SCs in hospital units where they had resided. CRE isolates were tested by real-time polymerase chain reaction for blaNDM. Medical records were reviewed for epidemiologic links; relatedness of isolates was evaluated by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). Infection control (IC) was assessed through staff interviews and direct observations. RESULTS: Two patients were initially identified with NDM-producing CRE during July-August 2012. A third case patient, admitted in May, was identified through microbiology records review. SC identified 5 additional case patients. Patients had resided in 11 different units before identification. All isolates were highly related by PFGE. WGS suggested 3 clusters of CRE. Combining WGS with epidemiology identified 4 units as likely transmission sites. NDM-producing CRE positivity in certain patients was not explained by direct epidemiologic overlap, which suggests that undetected colonized patients were involved in transmission. CONCLUSIONS: A 4-month outbreak of NDM-producing CRE occurred at a single hospital, highlighting the risk for spread of these organisms. Combined WGS and epidemiologic data suggested transmission primarily occurred on 4 units. Timely SC, combined with targeted IC measures, were likely responsible for controlling transmission.
Authors: Gina K Thomson; James W Snyder; Christi L McElheny; Kenneth S Thomson; Yohei Doi Journal: J Clin Microbiol Date: 2015-12-30 Impact factor: 5.948
Authors: Gustavo C Cerqueira; Ashlee M Earl; Christoph M Ernst; Yonatan H Grad; John P Dekker; Michael Feldgarden; Sinéad B Chapman; João L Reis-Cunha; Terrance P Shea; Sarah Young; Qiandong Zeng; Mary L Delaney; Diane Kim; Ellena M Peterson; Thomas F O'Brien; Mary Jane Ferraro; David C Hooper; Susan S Huang; James E Kirby; Andrew B Onderdonk; Bruce W Birren; Deborah T Hung; Lisa A Cosimi; Jennifer R Wortman; Cheryl I Murphy; William P Hanage Journal: Proc Natl Acad Sci U S A Date: 2017-01-17 Impact factor: 11.205
Authors: Nenad Macesic; Angela Gomez-Simmonds; Sean B Sullivan; Marla J Giddins; Samantha A Ferguson; Gautam Korakavi; David Leeds; Sarah Park; Kevin Shim; Madeleine G Sowash; Melanie Hofbauer; Ryan Finkel; Yue Hu; Jared West; Nora C Toussaint; William G Greendyke; Benjamin A Miko; Marcus R Pereira; Susan Whittier; Elizabeth C Verna; Anne-Catrin Uhlemann Journal: Clin Infect Dis Date: 2018-08-31 Impact factor: 9.079
Authors: Eduardo Castro-Nallar; Nur A Hasan; Thomas A Cebula; Rita R Colwell; Richard A Robison; W Evan Johnson; Keith A Crandall Journal: PeerJ Date: 2015-02-17 Impact factor: 2.984