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. 2022 Dec 1;7(6):e186.
doi: 10.1097/j.pbj.0000000000000186. eCollection 2022 Nov-Dec.

Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures

David Peres  1 , Paulo Figueiredo  2   3 , Paulo Andrade  2   3 , Nuno Rocha-Pereira  2   3 , Cláudia Carvalho  2   3 , Rita Ferraz  2   3 , Raquel Duro  2   3 , Arnaldo Dias  2 , Abel Gomes  2 , Cláudia Pereira  2 , Gisélia Braga  2 , Virginia Pereira  4 , Lino Azevedo  5 , Edgar Moniz  5 , Manuela Ribeiro  5 , Eugénia Ferreira  6 , Vera Manageiro  6 , José Teixeira  4 , Tiago Guimarães  5 , Manuela Caniça  6 , Carlos Alves  2   3
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Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures

David Peres et al. Porto Biomed J. .

Abstract

Background: KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal.

Methods: A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records.

Results: Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection.

Conclusions: Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.

Keywords: KPC-producing K pneumoniae; active surveillance cultures; antimicrobial resistance; carbapenemase-producing Enterobacteriaceae; contact precautions; outbreak.

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Conflict of interest statement

None.

Figures

Figure 1.
Figure 1.
Time evolution of cases (considering sample collection date) and ASC collected during the KPC-Kp outbreak—São João Hospital Center, Portugal, 2016. ASC, active surveillance culture (rectal swab); KPC-Kp, KPC-producing Klebsiella pneumoniae.
Figure 2.
Figure 2.
Spatiotemporal description of KPC-Kp outbreak cases (n=16)—São João Hospital Center, Portugal, 2016. KPC-Kp, KPC-producing Klebsiella pneumoniae; LTCF, long-term care facility.
See this image and copyright information in PMC

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References

    1. De Rosa FG, Corcione S, Cavallo R, Di Perri G, Bassetti M. Critical issues for Klebsiella pneumoniae KPC-carbapenemase producing K. pneumoniae infections: a critical agenda. Future Microbiol. 2015;10:283–294. - PubMed
    1. Nordemann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20:821–830. - PubMed
    1. Lee C-R, Lee JH, Park KS, Kim YB, Jeong BC, Lee SH. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: epidemiology, genetic context, treatment options, and detection methods. Front Microbiol. 2016;7:895. - PMC - PubMed
    1. Pitout JDD, Nordmann P, Poirel L. Carbapenemase-producing Klebsiella pneumoniae, a key pathogen set for global nosocomial dominance. Antimicrob Agents Chemother. 2015;59:5873–5884. - PMC - PubMed
    1. Munoz-Price LS, Poirel L, Bonomo RA, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis. 2013;13:785–796. - PMC - PubMed