Abstract
BackgroundKlebsiella pneumoniae has been responsible for a large number of clonal hospital outbreaks. However, some epidemiological changes have been observed since the emergence of CTX-M enzymes in K. pneumoniae.AimTo analyse the transmission dynamics of Extended Spectrum β-Lactamase-producing Klebsiella pneumoniae (ESBL-Kp) in an acute care hospital.MethodsIn 2015 a prospective cohort study was conducted. All new consecutive adult patients with ESBL-Kp isolates in all clinical samples were included. Patients with a previous known infection/colonization by ESBL-Kp and patients in high risk areas (e.g., intensive care units) were excluded. Cross-transmission was defined as the carriage of a clonally-related ESBL-Kp between newly diagnosed patients who shared the same ward for ≥48 h with another case, within a maximum time window of 4 weeks. ESBL-production was confirmed using the double-disk diffusion method and PCR. Clonal relationships were investigated by rep-PCR and multilocus sequence typing (MLST).ResultsSixty ESBL-Kp isolates from 60 patients were included and analysed. Infections and colonizations were classified as hospital-acquired (52%), healthcare-related (40%) or community-acquired (8%).High genetic diversity was detected. When epidemiological clinical data were combined with the rep-PCR, the patterns identified did not show any cases of cross-transmission. ESBL-Kp were detected in 12.5% of environmental samples. No clonal relationship could be established between environmental reservoirs and patients. The genetic mechanism detected in all strains was associated with blaCTX-M genes, and 97% were CTX-M-15.ConclusionsThe dynamics of ESBL-K. pneumoniae isolated in our setting could not be explained by clonal transmission from an index patient. A polyclonal spread of ESBL-Kp was identified.
Highlights
The epidemiology of healthcare-related infections has been characterized in recent decades by the emergence of Gram-negative multidrug-resistant organisms [1]
Patients with previous known infection/colonization by Extended-spectrum β-lactamases (ESBL)-Kp were excluded, as were adult patients admitted to intensive care units (ICU)
New index cases were detected with a median frequency of 2.5 patients per month and there were no outbreaks in any specific hospital area (Fig. 1)
Summary
The epidemiology of healthcare-related infections has been characterized in recent decades by the emergence of Gram-negative multidrug-resistant organisms [1]. This increase in resistance appears to be due largely to the production of extended-spectrum β-lactamases (ESBLs) among all Enterobacterales. K. pneumoniae has been responsible for a large number of hospital outbreaks. The first reports of CTX-M K. pneumoniae outbreaks were published in the 2000s [4] These CTX-M outbreaks were widespread in general hospital wards and their mortality rates are lower than those previously associated with SHV and TEM outbreaks. Klebsiella pneumoniae has been responsible for a large number of clonal hospital outbreaks. Some epidemiological changes have been observed since the emergence of CTX-M enzymes in K. pneumoniae
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