Stefan Borgmann1, Yvonne Pfeifer2, Laura Becker2, Beate Rieß3, Rabea Siegmund3, Ulrich Sagel4. 1. Department of Infectious Diseases and Infection Control, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany. stefan.borgmann@klinikum-ingolstadt.de. 2. Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany. 3. Department of Infectious Diseases and Infection Control, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany. 4. Clinical Institute of Hygiene and Microbiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria.
Abstract
PURPOSE: In January 2015, we noticed by rectal swab analyses that seven of 23 patients at an early rehabilitation ward had been colonized with carbapenem-resistant Klebsiella pneumoniae (CKP). Here, we describe risk factors for CKP acquisition. METHODS: In the present study, the outbreak is described and risk factors for CKP acquisition are examined, e.g., antibiotic treatment. Microbiological analyses including corresponding results were examined to study when colonization with CKP occurred and whether patients had suffered from diarrhea. To examine whether spread of bacteria was clonal, multi-locus sequence typing as well as Xbal macrorestriction and pulsed-field gel electrophoresis was performed. The presence of carbapenmase was examined by PCR analysis. Through univariate analysis of risk factors in the small study sample, the role of antibiotic consumption, isolation procedures, patient's age, gender, and Barthel index on colonization was elucidated. RESULTS: Clonal spread of the novel sequence type (ST)2255 was identified. Additionally, one patient was colonized with Escherichia coli and Serratia marcescens, both resistant to carbapenems, while a further patient carried another carbapenem-resistant E. coli strain. In all isolates, carbapenemase gene bla OXA-48 was found to be located on a conjugative plasmid (60 kb), suggesting in vivo transmission from CKP to E. coli and S. marcescens. Univariate tests indicated that antibiotic treatment was the only risk factor showing a significant association with being colonized by CKP. In addition, the likelihood of diarrhea appeared to be higher in this group. Antibiotic treatment was associated with CKP colonization, whereas patients´ age, gender, Barthel index at admission, and residence with a CKP-colonized roommate were not. Diarrhea also seemed to support to distribution of CKP. CONCLUSIONS: In this small outbreak, antibiotic treatment seemed to be the predominant risk factor for monoclonal transmission of bla OXA-48 positive CKP.
PURPOSE: In January 2015, we noticed by rectal swab analyses that seven of 23 patients at an early rehabilitation ward had been colonized with carbapenem-resistant Klebsiella pneumoniae (CKP). Here, we describe risk factors for CKP acquisition. METHODS: In the present study, the outbreak is described and risk factors for CKP acquisition are examined, e.g., antibiotic treatment. Microbiological analyses including corresponding results were examined to study when colonization with CKP occurred and whether patients had suffered from diarrhea. To examine whether spread of bacteria was clonal, multi-locus sequence typing as well as Xbal macrorestriction and pulsed-field gel electrophoresis was performed. The presence of carbapenmase was examined by PCR analysis. Through univariate analysis of risk factors in the small study sample, the role of antibiotic consumption, isolation procedures, patient's age, gender, and Barthel index on colonization was elucidated. RESULTS: Clonal spread of the novel sequence type (ST)2255 was identified. Additionally, one patient was colonized with Escherichia coli and Serratia marcescens, both resistant to carbapenems, while a further patient carried another carbapenem-resistant E. coli strain. In all isolates, carbapenemase gene bla OXA-48 was found to be located on a conjugative plasmid (60 kb), suggesting in vivo transmission from CKP to E. coli and S. marcescens. Univariate tests indicated that antibiotic treatment was the only risk factor showing a significant association with being colonized by CKP. In addition, the likelihood of diarrhea appeared to be higher in this group. Antibiotic treatment was associated with CKP colonization, whereas patients´ age, gender, Barthel index at admission, and residence with a CKP-colonized roommate were not. Diarrhea also seemed to support to distribution of CKP. CONCLUSIONS: In this small outbreak, antibiotic treatment seemed to be the predominant risk factor for monoclonal transmission of bla OXA-48 positive CKP.
Authors: Christoph Lübbert; Norman Lippmann; Thilo Busch; Udo X Kaisers; Tanja Ducomble; Tim Eckmanns; Arne C Rodloff Journal: Am J Infect Control Date: 2014-04 Impact factor: 2.918
Authors: F C Tenover; R D Arbeit; R V Goering; P A Mickelsen; B E Murray; D H Persing; B Swaminathan Journal: J Clin Microbiol Date: 1995-09 Impact factor: 5.948
Authors: Martin Kaase; Sven Schimanski; Reinhold Schiller; Bettina Beyreiß; Alexander Thürmer; Jörg Steinmann; Volkhard A Kempf; Christina Hess; Ingo Sobottka; Ines Fenner; Stefan Ziesing; Irene Burckhardt; Lutz von Müller; Axel Hamprecht; Ina Tammer; Nina Wantia; Karsten Becker; Thomas Holzmann; Martina Furitsch; Gabriele Volmer; Sören G Gatermann Journal: Int J Med Microbiol Date: 2016-05-13 Impact factor: 3.473
Authors: M Gharbi; L S P Moore; M Gilchrist; C P Thomas; K Bamford; E T Brannigan; A H Holmes Journal: Int J Antimicrob Agents Date: 2015-04-23 Impact factor: 5.283
Authors: Stefan Borgmann; Beate Rieß; David Meintrup; Ingo Klare; Guido Werner Journal: Int J Environ Res Public Health Date: 2020-08-21 Impact factor: 3.390