[Effective management of an outbreak with multiresistent Klebsiella pneumoniae in a neurorehabilitation unit]. / Effektives Management eines Ausbruchs mit multiresistenten Klebsiella pneumoniae in der Neurorehabilitation.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
; 61(5): 543-552, 2018 May.
Article
in De
| MEDLINE
| ID: mdl-29633038
ABSTRACT
BACKGROUND:
In addition to acute care hospitals, rehabilitation centres are increasingly confronted with multi-resistant pathogens. Long durations of stay and intensive treatments impose special hygienic challenges. MATERIAL ANDMETHODS:
We investigated an extended spectrum beta-lactamase-Klebsiella pneumoniae (ESBL-K. pneumoniae) outbreak in a neurorehabilitation centre. We defined confirmed cases as patients who stayed in the centre during the outbreak period and from whom ESBL-K. pneumoniae was isolated with the outbreak sequence type. Probable cases had an epidemiological link to at least one confirmed case but no isolate for typing. Next generation sequencing (NGS) was performed on 53 isolates from patients. Environmental sampling was performed. Systematic microbiological screening was implemented and ESBL-K. pneumoniae-positive patients were cohorted in a designated ward.RESULTS:
We identified 30 confirmed and 6 probable cases. NGS revealed three genetic clusters Cluster 1 - the outbreak cluster - with isolates of 30 cases (sequence type ST15), Cluster 2 with 7 patients (ST405) and Cluster 3 with 8 patients (ST414). In two patients, the outbreak strain developed further antibiotic resistance, one with colistin resistance and the other carbapenem resistance. The outbreak ceased after strict isolation measures.DISCUSSION:
Epidemiology and NGS results paired with the effectiveness of cohorting suggest that transmission occurred mainly from person to person in this outbreak. There was an apparent association of the probability to acquire ESBL-K. pneumoniae and treatment intensity, whereas infection rate was related to morbidity. The identification of the outbreak clone and additional clusters plus the development of additional antibiotic resistance shows the relevance of NGS and highlights the need for timely and efficient outbreak management.Key words
Full text:
1
Database:
MEDLINE
Main subject:
Rehabilitation Centers
/
Klebsiella Infections
/
Cross Infection
/
Disease Outbreaks
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Drug Resistance, Multiple, Bacterial
/
Neurological Rehabilitation
/
Anti-Bacterial Agents
Type of study:
Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Adult
/
Aged
/
Aged80
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
De
Year:
2018
Type:
Article