scholarly journals Endoscopic Retrograde Cholangiopancreatography–Associated AmpCEscherichia coliOutbreak

2015 ◽  
Vol 36 (6) ◽  
pp. 634-642 ◽  
Author(s):  
Kristen A. Wendorf ◽  
Meagan Kay ◽  
Christopher Baliga ◽  
Scott J. Weissman ◽  
Michael Gluck ◽  
...  
Keyword(s):  
Infection Control ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Gel Electrophoresis ◽  
Gene Sequencing ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Biliary Disease ◽  
Endoscopic Retrograde ◽  
Pulsed Field ◽  
E Coli

BACKGROUNDWe identified an outbreak of AmpC–producingEscherichia coliinfections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in ablaCMYgene and a distinctivefumC/ fimHtyping profile.OBJECTIVETo determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CRE. coliand AmpCE. colicirculating at hospital A.METHODSWe reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identicalblaCMY-2,fumC, andfimHalleles or related pulsed-field gel electrophoresis patterns.RESULTSThirty-five of 49 AmpCE. colitested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer’s recommended cleaning guidelines.CONCLUSIONRecommended reprocessing guidelines are not sufficient.Infect Control Hosp Epidemiol2015;00(0): 1–9

Molecular strain typing ofCampylobacter jejuniby pulsed-field gel electrophoresis in a single day

2001 ◽  
Vol 47 (7) ◽  
pp. 667-669 ◽  
Author(s):  
Sophie Michaud ◽  
Robert D Arbeit ◽  
Christiane Gaudreau
Keyword(s):  
Infection Control ◽  
Molecular Epidemiology ◽  
Campylobacter Jejuni ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Strain Typing ◽  
High Quality ◽  
Pulsed Field ◽  
Infection Control Measures

Rapid molecular strain typing is critical for effective outbreak investigation and implementation of infection control measures. Pulsed-field gel electrophoresis is a highly discriminatory technique for Campylobacter jejuni, but generally requires 3–5 days. We describe a simplified protocol for pulsed-field gel electrophoresis that provides high quality typing of C. jejuni isolates in a single day.Key words: pulsed-field gel electrophoresis, Campylobacter jejuni, molecular epidemiology.

Nosocomial Outbreak of a Novel Extended-Spectrum β-LactamaseSalmonella entericaSerotype Isangi Among Surgical Patients

2016 ◽  
Vol 37 (8) ◽  
pp. 954-961 ◽  
Author(s):  
Geehan Suleyman ◽  
Robert Tibbetts ◽  
Mary Beth Perri ◽  
Dora Vager ◽  
Yuan Xin ◽  
...  
Keyword(s):  
Infection Control ◽  
Gel Electrophoresis ◽  
Organ Transplant ◽  
The United States ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Surgical Patients ◽  
Multiple Control ◽  
Pulsed Field ◽  
Extended Spectrum

OBJECTIVENosocomial outbreaks caused bySalmonellaare rare. We describe the investigation and control of a cluster of novel extended-spectrum β-lactamase (ESBL)Salmonella entericaserotype Isangi in a hospital in southeastern Michigan.METHODSAn epidemiologic investigation, including case-control study, assessment of infection control practices and environmental cultures, was performed to identify modes of transmission. Healthcare workers (HCWs) exposed to case patients were screened. Strain relatedness was determined using pulsed-field gel electrophoresis (PFGE); ESBL confirmation was conducted using real-time PCR. Control measures were implemented to prevent further transmission.RESULTSBetween September 2 and October 22, 2015, 19 surgical patients, including 10 organ transplant recipients and 1 HCW, had positiveS.Isangi cultures. Of these case patients and HCW, 13 had gastroenteritis, 2 had bacteremia, 1 had surgical-site infection, and 4 were asymptomatic. Pulsed-field gel electrophoresis (PFGE) showed 89.5% similarity among the isolates in these cases. Isolates with resistant-phenotypes possessed plasmid-mediated CTX-M15 ESBL. A total of 19 case patients were compared with 57 control participants. Case patients had significantly higher odds of exposure to an intraoperative transesophageal (TEE) probe (adjusted odds ratio 9.0; 95% confidence interval, 1.12–72.60;P=.02). Possible cross-transmission occurred in the HCW and 2 patients. Cultures of TEE probes and the environment were negative. The outbreak ended after removal of TEE probes, modification of reprocessing procedures, implementation of strict infection control practices, and enhanced environmental cleaning.CONCLUSIONSWe report the first nosocomial ESBLS. Isangi outbreak in the United States. Multiple control measures were necessary to interrupt transmission of this gastrointestinal pathogen. Exposure to possibly contaminated TEE probes was associated with transmission. Periodic monitoring of reprocessing procedures of TEE probes may be required to ensure optimal disinfection.Infect Control Hosp Epidemiol2016;37:954–961

scholarly journals Molecular typing of Escherichia coli O157[ratio ]H7 (H−) isolates from cattle in Japan

1999 ◽  
Vol 122 (2) ◽  
pp. 337-341 ◽  
Author(s):  
M. AKIBA ◽  
T. MASUDA ◽  
T. SAMESHIMA ◽  
K. KATSUDA ◽  
M. NAKAZAWA
Keyword(s):  
Escherichia Coli ◽  
Molecular Typing ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Escherichia Coli O157 ◽  
Outbreak Strain ◽  
Pulsed Field ◽  
E Coli ◽  
Biological Methods ◽  
Pfge Profiles

A total of 77 Escherichia coli O157[ratio ]H7 (H−) isolates from cattle in Japan were investigated by molecular biological methods. Most of these isolates (43 isolates) possessed the stx2 gene, but not stx1. Fifteen bacteriophage types and 50 pulsed-field gel electrophoresis (PFGE) profiles were observed. One isolate was indistinguishable from the human outbreak strain by these methods. This indicates that cattle must be considered as a possible source of human E. coli O157[ratio ]H7 infection in Japan.

Listeria monocytogenes From Farm to Fork in a Brazilian Pork Production Chain

2020 ◽  
Vol 83 (3) ◽  
pp. 485-490 ◽  
Author(s):  
DANILO A. L. SILVA ◽  
CLARISSE V. BOTELHO ◽  
BRUNA T. F. MARTINS ◽  
RAFAELA M. TAVARES ◽  
ANDERSON C. CAMARGO ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Gel Electrophoresis ◽  
Virulence Genes ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Production Chain ◽  
Pork Production ◽  
Pulsed Field ◽  
Genetic Profiles ◽  
Different Sources

ABSTRACT Listeria monocytogenes contamination was assessed in different steps of a pork production chain. Ten lots of pigs were sampled at termination barns, at slaughter (after bleeding, after buckling, after evisceration, and after final washing), at processing (knives, deboning tables, and employees' hands), and of end products (ribs, shoulder, ham, and sausage). All samples (n = 670) were subjected to L. monocytogenes detection, and the obtained isolates (n = 18, identified as Listeria spp.) were characterized by their biochemical characteristics, serogroups, virulence genes, pulsed-field gel electrophoresis profiles, antibiotic resistances (ampicillin, penicillin, gentamicin, and sulfamethoxazole-trimethoprim), and adhesion abilities. The results revealed the low occurrence of Listeria spp. in the evaluated pork production chain. However, four tested sausage samples (40%) were positive for Listeria spp., with L. monocytogenes identified in two (20%) of these samples. Ten isolates were identified as L. monocytogenes (eight from serogroup 1/2a or 3a and two from serogroup 4b, 4d, or 4e): all isolates were also positive for the virulence-related genes hlyA, iap, plcA, actA, inlA, inlB, inlC, and inlJ and susceptible to the tested antibiotics. One sausage sample was contaminated by both serogroups 1/2a or 3a and 4b, 4d, or 4e. Isolates from serogroup 1/2a or 3a obtained during visits 5 and 6 presented distinct genetic profiles by pulsed-field gel electrophoresis, indicating that contamination may come from different sources. The adhesion potential exhibited by Listeria spp. isolates (n = 18) ranged from weak (serogroup 4b, 4d, or 4e) to moderate (L. innocua and L. monocytogenes serogroup 1/2a or 3a). Despite the low occurrence of L. monocytogenes, pathogenic serogroups were detected in sausages, demanding control measures by the industry. HIGHLIGHTS

Rapid Eradication of a Cluster ofSerratia marcescensin a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis

2004 ◽  
Vol 25 (9) ◽  
pp. 730-734 ◽  
Author(s):  
Kwan Kew Lai ◽  
Stephen P. Baker ◽  
Sally A. Fontecchio
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Gel Electrophoresis ◽  
Neonatal Intensive Care ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Pulsed Field ◽  
Contact Precautions ◽  
Control Study

AbstractObjective:To investigate a cluster of patients infected and colonized withSerratia marcescensin a neonatal intensive care unit (NICU).Methods:In June 2001, two neonates in the NICU had clinical infections withS. marcescensand one died. Infection control surveillance data for the NICU revealed that S.marcescenswas rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.Results:From June 2 through August 20, 2001, 11 neonates withS. marcescensinfection and colonization were identified. The incidence ofS. marcescensinfections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P< .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates withS. marcescenswere more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).Conclusions:A cluster ofS. marcescenswas quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.

Pulsed-Field Gel Electrophoresis Characterization of Shiga Toxin–Producing Escherichia coli O157 from Hides of Cattle at Slaughter

2002 ◽  
Vol 65 (7) ◽  
pp. 1172-1176 ◽  
Author(s):  
S. M. AVERY ◽  
A. SMALL ◽  
C.-A. REID ◽  
S. BUNCIC
Keyword(s):  
Escherichia Coli ◽  
Shiga Toxin ◽  
Gel Electrophoresis ◽  
Immunomagnetic Separation ◽  
Pulsed Field Gel Electrophoresis ◽  
Escherichia Coli O157 ◽  
Adult Cattle ◽  
Pulsed Field ◽  
E Coli ◽  
High Prevalence

Contamination of the brisket areas of the hides of healthy adult cattle with Shiga toxin–producing Escherichia coli O157 at slaughter in England was studied. In total, 73 cattle consignments comprising 584 animals delivered to one abattoir over 3 days during 1 week in July 2001 were studied: 26 cattle consignments arriving on Monday, 32 consignments arriving on Wednesday, and 15 consignments arriving on Friday. Consignment sizes ranged from 1 to 23 animals, with a mean consignment size of 8. The hide of the first animal to be slaughtered in each consignment was sampled by using a sponge swab moistened with 0.85% saline to rub an unmeasured brisket (ventral) area (ca. 30 by 30 cm). The process of isolating E. coli O157 from the swabs consisted of enrichment, screening with immunoprecipitation assay kits, and immunomagnetic separation. E. coli O157 was found on 24 of 73 (32.9%) cattle hides examined, and 21 of these 24 isolates produced Shiga toxins. The 24 E. coli O157 isolates produced six different pulsed-field gel electrophoresis profiles, and 18 (75%) of the isolates were of one prevalent clone. The high prevalence of one E. coli O157 clone on the hides of cattle at slaughter could be due to a high prevalence of that clone on the 18 farms involved (not investigated in the current study), in the postfarm transport or lairage environments, or both. Since the lairage environment, but not the farm of origin or the postfarm transport vehicle, was a factor common to all 18 cattle consignments, it could have played an important role in spreading the prevalent E. coli O157 clone to the cattle hides. Lairage pen floors and the stunning box floor were identified as the most probable sites along the unloading-to-slaughter route at which the brisket areas of cattle hides could become contaminated.

Molecular Characterization of Escherichia coli O157:H7 Hide Contamination Routes: Feedlot to Harvest

2006 ◽  
Vol 69 (6) ◽  
pp. 1240-1247 ◽  
Author(s):  
K. D. CHILDS ◽  
C. A. SIMPSON ◽  
W. WARREN-SERNA ◽  
G. BELLENGER ◽  
B. CENTRELLA ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Drinking Water ◽  
Gel Electrophoresis ◽  
Side Wall ◽  
Pulsed Field Gel Electrophoresis ◽  
Marker Genes ◽  
Escherichia Coli O157 ◽  
Pulsed Field ◽  
E Coli ◽  
Side Rail

This study was conducted to identify the origin of Escherichia coli O157:H7 contamination on steer hides at the time of harvest. Samples were collected from the feedlot, transport trailers, and packing plant holding pens and from the colons and hides of feedlot steers. A total of 50 hide samples were positive for E. coli O157:H7 in two geographical locations: the Midwest (25 positive hides) and Southwest (25 positive hides). Hide samples were screened, and the presence of E. coli O157: H7 was confirmed. E. coli O157:H7 isolates were fingerprinted by pulsed-field gel electrophoresis and subjected to multiplex PCR procedures for amplification of E. coli O157:H7 genes stx1, stx2, eaeA, fliC, rfbEO157, and hlyA. Feedlot water trough, pen floor, feed bunk, loading chute, truck trailer side wall and floor, packing plant holding pen floor and side rail, and packing plant cattle drinking water samples were positive for E. coli O157:H7. Pulsed-field gel electrophoresis banding patterns were analyzed after classifying isolates according to the marker genes present and according to packing plant. In this study, hide samples positive for E. coli O157:H7 were traced to other E. coli O157:H7–positive hide, colon, feedlot pen floor fecal, packing plant holding pen drinking water, and transport trailer side wall samples. Links were found between packing plant side rails, feedlot loading chutes, and feedlot pens and between truck trailer, different feedlots, and colons of multiple cattle. This study is the first in which genotypic matches have been made between E. coli O157:H7 isolates obtained from transport trailer side walls and those from cattle hide samples within the packing plant.

scholarly journals Emergence of Enterobacteriaceae Isolates Producing CTX-M Extended-Spectrum β-Lactamase in Austria

2006 ◽  
Vol 50 (2) ◽  
pp. 785-787 ◽  
Author(s):  
Alexandra Eisner ◽  
Elizabeth J. Fagan ◽  
Gebhard Feierl ◽  
Harald H. Kessler ◽  
Egon Marth ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
United Kingdom ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Pulsed Field ◽  
E Coli ◽  
The United Kingdom ◽  
Extended Spectrum ◽  
Epidemiological Link ◽  
Esbl Producers

ABSTRACT Among 149 extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae isolates collected from patients in southeast Austria from 1998 to 2004, 38 Escherichia coli isolates and 11 Klebsiella spp. were CTX-M producers. The proportion of CTX-M-producers among all ESBL producers rose from 0% in 1998 to 58% in 2004. In general, CTX-M-producers had heterogeneous pulsed-field gel electrophoresis patterns, but one E. coli isolate was identical to a United Kingdom epidemic CTX-M-15-producing strain, although no epidemiological link with the United Kingdom was apparent.

scholarly journals Απομόνωση και καθορισμός του γενότυπου αντοχής Gram-αρνητικών βακτηρίων από ωτίτιδα σκύλου ανθεκτικών στα νεότερα β-λακταμικά αντιμικροβιακά και τις φθοριοκινολόνες

2014 ◽  
Author(s):  
Ελπίδα Βιγγοπούλου
Keyword(s):  
Gel Electrophoresis ◽  
Multilocus Sequence Typing ◽  
Pulsed Field Gel Electrophoresis ◽  
Pulsed Field ◽  
E Coli

Σκοπός της διατριβής ήταν η απομόνωση Gram-αρνητικών στελεχών από περιστατικά ωτίτιδας στο σκύλο ανθεκτικών σε ευρέος φάσματος αντιμικροβιακά, συγκεκριμένα στις φθοριοκινολόνες και στα νεότερα β-λακταμικά αντιμικροβιακά, η διερεύνηση και ο καθορισμός του γενότυπου αντοχής τους με κύριο στόχο τη μελέτη του επιπολασμού και της διασποράς των γενετικών τους στοιχείων αντοχής. Όλα τα Gram-αρνητικά στελέχη που απομονώνονταν εξετάζονταν καταρχήν με τη μέθοδο Kirby-Bauer ως προς την αντοχή τους στο ναλιδιξικό οξύ, στις φθοριοκιονολόνες (σιπροφλοξακίνη, ενροφλοξακίνη, μαρμποφλοξακίνη και πραδοφλοξακίνη), στα β-λακταμικά αντιμικροβιακά (αμπικιλλίνη, αμοξυκιλλίνη-κλαβουλανικό οξύ, πιπερακιλλίνη-ταζομπακτάμη, κεφοξιτίνη, κεφουροξίμη, κεφταζιδίμη, κεφοπεραζόνη, κεφτριαξόνη, κεφοταξίμη, κεφεπίμη, αζτρεονάμη, ιμιπενέμη και μεροπενέμη) και σε άλλα αντιμικροβιακά σύμφωνα με τις συστάσεις του CLSI και του EUCAST. Ακολούθως, σε όλα τα ωτικά στελέχη προσδιορίστηκε η ελάχιστη ανασταλτική συγκέντρωση (MIC) του ναλιδιξικού οξέος και των φθοριοκινολονών, σιπροφλοξακίνη, ενροφλοξακίνη, μαρμποφλοξακίνη και πραδοφλοξακίνη με τη μέθοδο των διαδοχικών μικροαραιώσεων. Επιπλέον, σε επιλεγμένα στελέχη της Ε. coli υπολογίστηκε η MIC των φθοριοκινολονών, παρουσία ενός αναστολέα αντλίας εκροής, με σκοπό τον καθορισμό της υπερέκφρασης της αντλίας εκροής. Όλα τα στελέχη που απομονώθηκαν εξετάστηκαν με τεχνικές της PCR για την ανίχνευση των PMQR γονιδίων. Ακολούθως, όλα τα στελέχη που εμφάνιζαν αντοχή σε όλες τις φθοριοκινολόνες που εξετάστηκαν ή αντοχή μόνο σε μία φθοριοκινολόνη ή που έφεραν PMQR γονίδιο(α), εξετάστηκαν με τεχνικές της PCR, για την ενίσχυση τμημάτων των γονιδίων, συμπεριλαμβανομένης της QRDR περιοχής, για την ανίχνευση των μεταλλάξεων στα ένζυμα στόχους (DNA γυράση και τοποϊσομεράση IV) των φθοριοκινολονών. Επιπρόσθετα, ανιχνεύτηκαν και χαρακτηρίστηκαν οι μηχανισμοί αντοχής στις εκτεταμένου φάσματος κεφαλοσπορίνες σε τρία κλινικά στελέχη και σε επτά στελέχη κοπράνων της E. coli που παρουσίαζαν πολυανθεκτικότητα και τα οποία είχαν απομονωθεί από σκύλο που έπασχε από υποτροπιάζουσα ωτίτιδα και στον οποίο είχαν χορηγηθεί φθοριοκινολόνες και αναστολέας των β-λακταμών με αποτέλεσμα να αποικιστεί για μεγάλο χρονικό διάστημα. Ο προσδιορισμός της MIC έγινε με τη μέθοδο των διαδοχικών μικροαραιώσεων. Η φαινοτυπική ανίχνευση της παραγωγής των β-λακταμασών διενεργήθηκε με τη δοκιμή συνέργειας του διπλού δίσκου, τη δοκιμή των τριών-διαστάσεων, τη δοκιμή βορονικού οξέος και με την αναλυτική ισοηλεκτρική εστίαση. Όλα τα στελέχη της E. coli εξετάστηκαν με τεχνικές της PCR με σκοπό την ανίχνευση των γονιδίων που κωδικοποιούν AmpCs και ESBLs. Η μεταβίβαση των bla γονιδίων μέσω πλασμιδίων μελετήθηκε με την εφαρμογή πειραμάτων σύζευξης. Η ταυτοποίηση των πλασμιδίων έγινε με τις μεθόδους PCR-based-replicon-typing, S1-νουκλεάση-PFGE και plasmid-multilocus sequence typing. Το γενετικό περιβάλλον των bla γονιδίων καθορίστηκε με PCR χαρτογράφηση. Ο προσδιορισμός της γενετικής σχέσης των στελεχών της E. coli έγινε με τις μεθόδους multilocus sequence typing, ERIC2 PCR και Pulsed Field Gel Electrophoresis. Επιπλέον, αναλύθηκαν οι μηχανισμοί αντοχής στις εκτεταμένου φάσματος κεφαλοσπορίνες σε κλινικό ωτικό στέλεχος του P. mirabilis που έφερε χρωμοσωμικά εντοπισμένο blaCMY-2 γονίδιο. Ο προσδιορισμός της MIC έγινε με τη μέθοδο των διαδοχικών μικροαραιώσεων. Η φαινοτυπική ανίχνευση της παραγωγής των β-λακταμασών συνδυάστηκε με τις γενοτυπικές αναλύσεις (PCRs, ανάλυσης της αλληλουχίας, πειράματα σύζευξης, S1-νουκλεάση-PFGE και PCR χαρτογράφηση), η χρωμοσωμική έναντι της πλασμιδιακής εντόπισης εκτιμήθηκε με τη διεξαγωγή της I-CeuI ανάλυσης. Τέλος, σε δύο στελέχη του E. cloacae που παρουσίαζαν αντοχή στους αναστολείς των β-λακταμασών και στις κεφαμυκίνες έγινε έλεγχος παραγωγής επαγώγιμων ή σταθερά παραγόμενων AmpC β-λακταμασών. Ο προσδιορισμός της MIC έγινε με τη μέθοδο των διαδοχικών μικροαραιώσεων και εφαρμόστηκε το D-test με σκοπό τη φαινοτυπική ανίχνευση της παραγωγής των επαγώγιμων β-λακταμασών.

Investigation and invention in carbapenem-resistant Klebsiella pneumoniae infection cases associated with Endoscopic retrograde cholangiopancreatography operation

2019 ◽  
Author(s):  
Yuhua Yuan ◽  
Qiucheng Shi ◽  
Li Fang ◽  
Jin Zhao ◽  
Yaqin Ni ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Molecular Typing ◽  
Susceptibility Testing ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Endoscopic Retrograde ◽  
Response System ◽  
Carbapenem Resistant ◽  
Operation Unit

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is associated with nosocomial infections that poses a serious threat to public health. According to a previous study, endoscopic retrograde cholangiopancreatography (ERCP) is considered a risk factor of CRKP transmission in the hospital. Methods: In this study, two cases infected with CRKP after ERCP were investigated. The origin of CRKP was determined by collecting the isolates from patients and screening the environment for ERCP units and the specific endoscopes. The antimicrobials susceptibility testing and molecular typing were performed for these CRKP. After post-ERCP infection happened, the procedure of endoscope disinfection was changed and hydrogen dioxide disinfection of ERCP unit was performed.Results: A total of five CRKP isolates were obtained from patients and screening the environment for ERCP units and the specific endoscopes, including three from the patients and two from the ERCP operating room. The CRKP from the patients and environment were both ST11, and the pulsed-field gel electrophoresis results showed that they shared identical bands, which indicated that the contaminated environment was associated with the nosocomial CRKP infections. After the control measures of endoscopes and hydrogen dioxide disinfection, post-ERCP infection decreased in the next six months.Conclusion: Early warning and response system should be established to control the spreading of CRKP in ERCP operation unit.

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