An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread.

We describe an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) ST258 that occurred in two institutions (a hospital and a nursing home) in the Netherlands between July and December 2013. In total, six patients were found to be positive for KPC-KP. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and tigecycline. In all settings, extensive environmental contamination was found. Whole genome sequencing revealed the presence of bla KPC-2 and bla SHV-12 genes, as well as the close relatedness of patient and environmental isolates. In the hospital setting, one transmission was detected, despite contact precautions. After upgrading to strict isolation, no further spread was found. After the transfer of the index patient to a nursing home in the same region, four further transmissions occurred. The outbreak in the nursing home was controlled by transferring all KPC-KP-positive residents to a separate location outside the nursing home, where a dedicated nursing team cared for patients. This outbreak illustrates that the spread of pan-resistant Enterobacteriaceae can be controlled, but may be difficult, particularly in long-term care facilities. It, therefore, poses a major threat to patient safety. Clear guidelines to control reservoirs in and outside the hospitals are urgently needed.

Otoacoustic emission measurements in evaluation of the immediate effect of ventilation tube insertion in children.

It is generally acknowledged that hearing assessment is needed before and after possible surgical intervention in children with otitis media with effusion. The conventional method in young children is visual reinforcement audiometry, which requires much time and cooperation from the child. The assessment of otoacoustic emissions may be an alternative, as it is proven to be rapid, easy, and objective as a screening procedure. We studied the applicability of click-evoked otoacoustic emissions to assess hearing acuity in children with otitis media with effusion who were scheduled for ventilation tube insertion. To avoid cooperation problems, the measurements were performed in the operating room immediately before and after ventilation tube insertion with the child under general anesthesia. None of the ears tested (n = 29) showed any increase in otoacoustic emissions when preoperative and postoperative levels were compared. At follow-up visits, however, 80% of the tested ears did. The acute outcome may be best explained by assuming that the surgical manipulations themselves were responsible, either through their fatiguing effects on the outer hair cells caused by the suctioning noise, or through their mechanical effects on the middle ear processes that govern reverse transmission from the cochlea to the outer ear canal. We conclude that it is not worthwhile to measure otoacoustic emissions directly after ventilation tube insertion to assess the effect on hearing acuity, although they may be valuable in the outpatient setting.