Korean J Crit Care Med.  2017 Feb;32(1):29-38. 10.4266/kjccm.2016.00731.

Outbreak of Imipenemase-1-Producing Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit

Affiliations
  • 1Department of Internal Medicine, National Research Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea. aiteite1@naver.com
  • 2Department of Infection Control, Kosin Medical College, Busan, Korea.
  • 3Department of Laboratory Medicine, Medical Center Paju Hospital, Paju, Korea.
  • 4Division of Vaccine Research, Center for Infectious Disease, National Research Institute of Health, Centers for Disease Control and Prevention, Cheongju, Korea.

Abstract

BACKGROUND
Carbapenem-resistant Enterobacteriaceae (CRE) with acquired metallo β-lactamase (MBL) resistance have been increasingly reported worldwide and associated with significant mortality and morbidity. Here, an outbreak of genetically related strains of Klebsiella pneumoniae producing the imipenemase (IMP)-1 MBL in a medical intensive care unit (MICU) in Korea is reported.
METHODS
Since isolating carbapenem-resistant K. pneumoniae (CRKP) at the MICU of the hospital on August 10, 2011, surveillance cultures for CRE in 31 hospitalized patients were performed from August to September 2011. Carbapenem resistance was determined based on the disk diffusion method outlined in the Clinical and Laboratory Standards Institute guidelines. Polymerase chain reaction (PCR) was performed for genes coding for β-lactamase. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). In addition, a surveillance study of environmental cultures and health-care workers (HCWs) was conducted in the MICU during the same time frame.
RESULTS
During the study period, non-duplicated CRKP specimens were discovered in four patients in the MICU, suggestive of an outbreak. On August 10, 2011, CRKP was isolated from the sputum of a 79-year-old male patient who was admitted to the MICU. A surveillance study to detect additional CRE carriers by rectal swab revealed an additional three CRKP isolates. PCR and sequencing of the four isolates identified the presence of the IMP-1 gene. In addition, PFGE showed that the four isolated strains were genetically related. CRE was not identified in specimens taken from the hands of HCWs or other environmental sources during surveillance following the outbreak. Transmission of the carbapenemase-producing Enterobacteriaceae strain was controlled by isolation of the patients and strict contact precautions.
CONCLUSIONS
This study shows that rapid and systemic detection of CRE and strict infection controls are important steps in preventing nosocomial transmission.

Keyword

beta-lactamase IMP-1; carbapenem resistance; disease outbreaks; Klebsiella pneumoniae

MeSH Terms

Aged
Clinical Coding
Critical Care*
Diffusion
Disease Outbreaks
Drug Resistance, Bacterial
Electrophoresis, Gel, Pulsed-Field
Enterobacteriaceae
Hand
Humans
Infection Control
Intensive Care Units*
Klebsiella pneumoniae*
Klebsiella*
Korea
Male
Methods
Mortality
Pneumonia
Polymerase Chain Reaction
Sputum

Figure

  • Figure 1. Timeline for the described CRE outbreak in the MICU, 2011. CRE: carbapenem-resistant Enterobacteriaceae; MICU: medical intensive care unit; VRE: vancomycin-resistant enterococcus; PFGE: pulsed-field gel electrophoresis.

  • Figure 2. Dendrogram of PFGE macro restriction patterns generated with the RFLPrint computer software. The scale indicates percent similarity. PFGE profiles of K. pneumoniae strains isolated from 4 patients in the MICU. PFGE: pulsed-field gel electrophoresis; MICU: medical intensive care unit.


Reference

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