1887
Surveillance Open Access
Like 0

Abstract

Background

Two epidemiologically-unrelated clusters of carbapenemase (KPC)-producing were detected among several healthcare facilities (HCF) in Finland by routine surveillance using whole genome sequencing (WGS).

Aim

The objective was to investigate transmission chains to stop further spread of the responsible strain.

Methods

In this observational retrospective study, cases were defined as patients with KPC-3 sequence type (ST)512 strain detected in Finland from August 2013 to May 2018. Environmental specimens were obtained from surfaces, sinks and toilets in affected wards. WGS was performed on cultures using Illumina MiSeq platform and data were analysed using Ridom SeqShere software core genome multilocus sequence typing (cgMLST) scheme. Epidemiological information of the cases was provided by HCFs.

Results

We identified 20 cases in six HCFs: cluster 1 included 18 cases in five HCFs and cluster 2 two cases in one HCF. In cluster 1, a link with a foreign country was unclear, 6/18 cases without overlapping stay had occupied the same room in one of the five HCFs within > 3 years. In cluster 2, the index case was transferred from abroad, both cases occupied the same room 8 months apart. A strain identical to that of the two cases in cgMLST was isolated from the toilet of the room, suggesting a clonal origin.

Conclusions

The clusters were mostly related to case transfer between facilities and likely involved environmental transmission. We show that CPE surveillance using WGS and collaboration between hospitals are crucial to identify clusters and trace transmission chains.

Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2019.24.38.1800522
2019-09-19
2019-10-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.38.1800522
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/24/38/eurosurv-24-38-2.html?itemId=/content/10.2807/1560-7917.ES.2019.24.38.1800522&mimeType=html&fmt=ahah

References

  1. Tzouvelekis LS, Markogiannakis A, Psichogiou M, Tassios PT, Daikos GL. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev. 2012;25(4):682-707.  https://doi.org/10.1128/CMR.05035-11  PMID: 23034326 
  2. Munoz-Price LS, Poirel L, Bonomo RA, Schwaber MJ, Daikos GL, Cormican M, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis. 2013;13(9):785-96.  https://doi.org/10.1016/S1473-3099(13)70190-7  PMID: 23969216 
  3. European Centre for Disease Prevention and Control. Rapid risk assessment: Carbapenem-resistant Enterobacteriaceae - first update 4 June 2018. Stockholm: ECDC; 2018.
  4. Hardiman CA, Weingarten RA, Conlan S, Khil P, Dekker JP, Mathers AJ, et al. Horizontal Transfer of Carbapenemase-Encoding Plasmids and Comparison with Hospital Epidemiology Data. Antimicrob Agents Chemother. 2016;60(8):4910-9.  https://doi.org/10.1128/AAC.00014-16  PMID: 27270289 
  5. Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT, et al. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis. 2017;17(2):153-63.  https://doi.org/10.1016/S1473-3099(16)30257-2  PMID: 27866944 
  6. Errico G, Gagliotti C, Monaco M, Masiero L, Gaibani P, Ambretti S, et al. . Colonization and infection due to carbapenemase-producing Enterobacteriaceae in liver and lung transplant recipients and donor-derived transmission: a prospective cohort study conducted in Italy. Clin Microbiol Infect. 2019;25(2):203-9.  https://doi.org/10.1016/j.cmi.2018.05.003  PMID: 29800674 
  7. Snitkin ES, Zelazny AM, Thomas PJ, Stock F, Henderson DK, Palmore TN, et al. NISC Comparative Sequencing Program Group. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med. 2012;4(148):148ra116.  https://doi.org/10.1126/scitranslmed.3004129  PMID: 22914622 
  8. Heinrichs A, Argudín MA, De Mendonça R, Deplano A, Roisin S, Dodémont M, et al. An Outpatient Clinic as a Potential Site of Transmission for an Outbreak of New Delhi Metallo-β-Lactamase-producing Klebsiella pneumoniae Sequence Type 716: A Study Using Whole-genome Sequencing. Clin Infect Dis. 2019;68(6):993-1000.  https://doi.org/10.1093/cid/ciy581  PMID: 30032179 
  9. López-Camacho E, Paño-Pardo JR, Ruiz-Carrascoso G, Wesselink JJ, Lusa-Bernal S, Ramos-Ruiz R, et al. Population structure of OXA-48-producing Klebsiella pneumoniae ST405 isolates during a hospital outbreak characterised by genomic typing. J Glob Antimicrob Resist. 2018;15:48-54.  https://doi.org/10.1016/j.jgar.2018.06.008  PMID: 29940334 
  10. Albiger B, Glasner C, Struelens MJ, Grundmann H, Monnet DLEuropean Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) working group. Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015. Euro Surveill. 2015;20(45):30062.  https://doi.org/10.2807/1560-7917.ES.2015.20.45.30062  PMID: 26675038 
  11. Österblad M, Kirveskari J, Hakanen AJ, Tissari P, Vaara M, Jalava J. Carbapenemase-producing Enterobacteriaceae in Finland: the first years (2008-11). J Antimicrob Chemother. 2012;67(12):2860-4.  https://doi.org/10.1093/jac/dks299  PMID: 22855858 
  12. Kanerva M, Skogberg K, Ryynänen K, Pahkamäki A, Jalava J, Ollgren J, et al. Coincidental detection of the first outbreak of carbapenemase-producing Klebsiella pneumoniae colonisation in a primary care hospital, Finland, 2013. Euro Surveill. 2015;20(26):21172.  https://doi.org/10.2807/1560-7917.ES2015.20.26.21172  PMID: 26159309 
  13. Kolho E, Lyytikäinen O, Jalava J. Ohje moniresistenttien mikrobien tartunnantorjunnasta. [National guideline for control of multidrug-resistant microbes]. Helsinki: National Institute for Health and Welfare (THL); 2017. Finnish. Available from: http://urn.fi/URN:ISBN:978-952-302-943-9
  14. Kluytmans-van den Bergh MF, Rossen JW, Bruijning-Verhagen PC, Bonten MJ, Friedrich AW, Vandenbroucke-Grauls CM, et al. Whole-Genome Multilocus Sequence Typing of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae. J Clin Microbiol. 2016;54(12):2919-27.  https://doi.org/10.1128/JCM.01648-16  PMID: 27629900 
  15. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Versions 3.1-8.1, 2013-2018. Växjö: EUCAST; 2018. Available from: http://www.eucast.org/clinical_breakpoints/
  16. Pasanen T, Koskela S, Mero S, Tarkka E, Tissari P, Vaara M, et al. Rapid molecular characterization of Acinetobacter baumannii clones with rep-PCR and evaluation of carbapenemase genes by new multiplex PCR in Hospital District of Helsinki and Uusimaa. PLoS One. 2014;9(1):e85854.  https://doi.org/10.1371/journal.pone.0085854  PMID: 24465749 
  17. Jolley KA, Maiden MC. BIGSdb: Scalable analysis of bacterial genome variation at the population level. BMC Bioinformatics. 2010;11(1):595.  https://doi.org/10.1186/1471-2105-11-595  PMID: 21143983 
  18. Inouye M, Dashnow H, Raven LA, Schultz MB, Pope BJ, Tomita T, et al. SRST2: Rapid genomic surveillance for public health and hospital microbiology labs. Genome Med. 2014;6(11):90.  https://doi.org/10.1186/s13073-014-0090-6  PMID: 25422674 
  19. Pitout JD, Nordmann P, Poirel L. Carbapenemase-Producing Klebsiella pneumoniae, a Key Pathogen Set for Global Nosocomial Dominance. Antimicrob Agents Chemother. 2015;59(10):5873-84.  https://doi.org/10.1128/AAC.01019-15  PMID: 26169401 
  20. Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Biddle JW, Steward CD, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 2001;45(4):1151-61.  https://doi.org/10.1128/AAC.45.4.1151-1161.2001  PMID: 11257029 
  21. Osterblad M, Kirveskari J, Koskela S, Tissari P, Vuorenoja K, Hakanen AJ, et al. First isolations of KPC-2-carrying ST258 Klebsiella pneumoniae strains in Finland, June and August 2009. Euro Surveill. 2009;14(40):19349.  https://doi.org/10.2807/ese.14.40.19349-en  PMID: 19822122 
  22. Tofteland S, Naseer U, Lislevand JH, Sundsfjord A, Samuelsen O. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One. 2013;8(3):e59015.  https://doi.org/10.1371/journal.pone.0059015  PMID: 23536849 
  23. Pantel A, Richaud-Morel B, Cazaban M, Bouziges N, Sotto A, Lavigne JP. Environmental persistence of OXA-48-producing Klebsiella pneumoniae in a French intensive care unit. Am J Infect Control. 2016;44(3):366-8.  https://doi.org/10.1016/j.ajic.2015.09.021  PMID: 26521704 
  24. Clarivet B, Grau D, Jumas-Bilak E, Jean-Pierre H, Pantel A, Parer S, et al. Persisting transmission of carbapenemase-producing Klebsiella pneumoniae due to an environmental reservoir in a university hospital, France, 2012 to 2014. Euro Surveill. 2016;21(17):30213.  https://doi.org/10.2807/1560-7917.ES.2016.21.17.30213  PMID: 27168586 
  25. Garvey MI, Bradley CW, Jumaa P. Environmental decontamination following occupancy of a burns patient with multiple carbapenemase-producing organisms. J Hosp Infect. 2016;93(2):136-40.  https://doi.org/10.1016/j.jhin.2016.01.006  PMID: 26895617 
  26. Leitner E, Zarfel G, Luxner J, Herzog K, Pekard-Amenitsch S, Hoenigl M, et al. Contaminated handwashing sinks as the source of a clonal outbreak of KPC-2-producing Klebsiella oxytoca on a hematology ward. Antimicrob Agents Chemother. 2015;59(1):714-6.  https://doi.org/10.1128/AAC.04306-14  PMID: 25348541 
  27. Carling PC. Wastewater drains: epidemiology and interventions in 23 carbapenem-resistant organism outbreaks. Infect Control Hosp Epidemiol. 2018;39(8):972-9.  https://doi.org/10.1017/ice.2018.138  PMID: 29950189 
  28. Solter E, Adler A, Rubinovitch B, Temkin E, Schwartz D, Ben-David D, et al. Israeli National Policy for Carbapenem-Resistant Enterobacteriaceae Screening, Carrier Isolation and Discontinuation of Isolation. Infect Control Hosp Epidemiol. 2018;39(1):85-9.  https://doi.org/10.1017/ice.2017.211  PMID: 29241475 
  29. Friedman ND, Carmeli Y, Walton AL, Schwaber MJ. Carbapenem-Resistant Enterobacteriaceae: A Strategic Roadmap for Infection Control. Infect Control Hosp Epidemiol. 2017;38(5):580-94.  https://doi.org/10.1017/ice.2017.42  PMID: 28294079 
/content/10.2807/1560-7917.ES.2019.24.38.1800522
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error