C O'Connor1, M Cormican2, T W Boo2, E McGrath3, B Slevin4, A O'Gorman4, M Commane4, S Mahony5, E O'Donovan4, J Powell6, R Monahan6, C Finnegan6, M G Kiernan5, J C Coffey5, L Power6, N H O'Connell1, C P Dunne7. 1. Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland. 2. School of Medicine National University of Ireland Galway, Galway, Ireland; Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland. 3. Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland. 4. Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland. 5. Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland. 6. Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland. 7. Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland. Electronic address: colum.dunne@ul.ie.
Abstract
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-β-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases. AIM: To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures. METHODS: This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates. FINDINGS: This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 μg/mL. All were tigecycline susceptible (MICs ≤1 μg/mL). One isolate was colistin resistant (MIC 4.0 μg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected. CONCLUSION: The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk. Copyright Â
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-β-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases. AIM: To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures. METHODS: This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates. FINDINGS: This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 μg/mL. All were tigecycline susceptible (MICs ≤1 μg/mL). One isolate was colistin resistant (MIC 4.0 μg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected. CONCLUSION: The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk. Copyright Â
Authors: Colum P Dunne; Minna M Keinänen-Toivola; Anne Kahru; Birgit Teunissen; Hulya Olmez; Isabel Gouveia; Luis Melo; Kazimierz Murzyn; Martina Modic; Merja Ahonen; Pete Askew; Theofilos Papadopoulos; Christian Adlhart; Francy R L Crijns Journal: Bioengineered Date: 2017-05-19 Impact factor: 3.269
Authors: Bláthnaid M Mahon; Carina Brehony; Elaine McGrath; James Killeen; Martin Cormican; Paul Hickey; Shane Keane; Belinda Hanahoe; Ann Dolan; Dearbháile Morris Journal: Euro Surveill Date: 2017-04-13
Authors: Raymond O'Connor; Jane O'Doherty; Andrew O'Regan; Aoife O'Neill; Claire McMahon; Colum P Dunne Journal: BMJ Open Date: 2019-02-15 Impact factor: 2.692
Authors: A P Magiorakos; K Burns; J Rodríguez Baño; M Borg; G Daikos; U Dumpis; J C Lucet; M L Moro; E Tacconelli; G Skov Simonsen; E Szilágyi; A Voss; J T Weber Journal: Antimicrob Resist Infect Control Date: 2017-11-15 Impact factor: 4.887
Authors: Colum P Dunne; Phelim Ryan; Roisin Connolly; Suzanne S Dunne; Mohammed A Kaballo; James Powell; Bernie Woulfe; Nuala H O'Connell; Rajnish K Gupta Journal: Infect Prev Pract Date: 2020-02-01