Outbreak due to a Klebsiella pneumoniae strain harbouring KPC-2 and VIM-1 in a German university hospital, July 2010 to January 2011

M Kaase,E Steinmann,A Paul,M Damman,J Buer,F Saner,W Popp,P M Rath,J Steinmann,S Gatermann

doi:10.2807/ese.16.33.19944-en

Abstract

We describe the epidemiology and characteristics of the pathogen and patients (n=7) associated with an outbreak of a carbapenem-resistant Klebsiella pneumoniae (CRKP) strain in a German university hospital from July 2010 to January 2011. Species identification and detection of carbapenem resistance were carried out using standard microbiological procedures. Carbapenemases were detected by phenotypic methods and specific polymerase chain reactions (PCRs). DNA fingerprinting profiles were performed with repetitive sequence-based PCR. Medical records of colonised or infected patients were retrospectively reviewed. Antibiotic resistance profiles, PCR-specific amplification products and genotyping demonstrated that the outbreak occurred because of the spread of a single CRKP clone harbouring both KPC-2 and VIM-1. Five of the seven patients had invasive infections with the CRKP strain; the deaths of four of them were directly related to the infection. Early implementation of infection control interventions brought about efficient containment of further cross-transmission. Rapid dissemination of carbapenemase-producing Enterobacteriaceae is a serious concern in patient care and is a problem that has emerged in western Europe.

Highlights

Enterobacteriaceae are widespread worldwide and frequently exhibit resistance to extended-spectrum beta-lactamases (ESBLs) [1]
Carbapenem-resistant K. pneumoniae (CRKP) strains were isolated from seven patients hospitalised in the intensive care unit (ICU) of the Department of General, Visceral and Transplant Surgery of the University Hospital Essen
The epidemiological and molecular investigations showed that a single K. pneumoniae strain that produced both VIM-1 and Klebsiella pneumoniae carbapenemases (KPC)-2 was responsible for the outbreak

Summary

Introduction

Enterobacteriaceae are widespread worldwide and frequently exhibit resistance to extended-spectrum beta-lactamases (ESBLs) [1]. The frequent use of carbapenems, combined with the transmissibility of resistance determinants mediated by plasmids, transposons and gene cassettes, has contributed to the increase of carbapenem resistance by Enterobacteriaceae [2,3] In countries such as the United States, Israel and Greece, carbapenemase-producing Enterobacteriaceae have www.eurosurveillance.org emerged and the dissemination of these multidrugresistant pathogens has become a problem in the clinical care of patients and in public health [4,5,6]. Invasive infections with these organisms have been associated with high rates of morbidity and mortality, due to their resistance to most available antimicrobial agents [7,8,9]. Patients who are hospitalised for prolonged periods and those with severe underlying disease are at high risk of acquiring these types of pathogens [10]

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