Persisting intrahospital transmission of multidrug-resistant Klebsiella pneumoniae and challenges for infection control

AbstractIn the past several decades, the incidence of Klebsiella pneumoniae harboring resistance mechanisms against multiple antibiotic agents has increased on a global scale. We discuss reasons for ongoing transmission of multidrug-resistant K. pneumoniae in healthcare settings, which has resulted in the successful spread and establishment of this pathogen. It is now one of the most important causes of healthcare-associated infections worldwide.

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Healthcare-associated infections and infection control

Oxford Textbook of Geriatric Medicine ◽

10.1093/med/9780198701590.003.0087 ◽

2017 ◽

pp. 667-674

Author(s):

Pascal Astagneau ◽

Elise Seringe ◽

François Bricaire

Keyword(s):

Infection Control ◽

Older People ◽

Multidrug Resistant ◽

Control Measures ◽

Resistant Bacteria ◽

Healthcare Associated Infections ◽

Infection Control Measures ◽

Poor Nutritional Status ◽

Healthcare Associated

Healthcare-associated infections (HAI) in older people frequently occur in mid or long-term cares facilities. The most frequent infections are those of the urinary tract, respiratory tract, skin/soft tissue, and gastrointestinal tract. The spectrum of pathogens are different in epidemic and endemic situations. Outbreaks occurring in long-term care frequently involve seasonal viruses such influenza, scabies, and multidrug-resistant bacteria such as Clostridium difficile. Ageing is a risk factor for HAI, which impairs immunological, metabolical, and neurological functions. Indwelling devices, poor nutritional status, and lack of mobility also increase the infection risk in the cared-for elderly. Infection control measures have to be implemented according to standard recommendations, including the use of alcohol-based hand rubs. Control measures should be adapted to the organization of healthcare facilites for older people, in particular environment and poor staff ressources. Focus should be made on vaccination programme of healthcare staff, especially against influenza.

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Prior Antibiotic Therapy and the Onset of Healthcare-Associated Infections Sustained by Multidrug-Resistant Klebsiella pneumoniae in Intensive Care Unit Patients: A Nested Case–Control Study

Antibiotics ◽

10.3390/antibiotics10030302 ◽

2021 ◽

Vol 10 (3) ◽

pp. 302

Author(s):

Giuseppe Migliara ◽

Valentina Baccolini ◽

Claudia Isonne ◽

Sara Cianfanelli ◽

Carolina Di Paolo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Case Control Study ◽

Multidrug Resistant ◽

Case Control ◽

Healthcare Associated Infections ◽

Healthcare Associated ◽

Nested Case Control ◽

Control Study

Epidemiological research has demonstrated direct relationships between antibiotic consumption and the emergence of multidrug-resistant (MDR) bacteria. In this nested case–control study, we assessed whether prior exposure to antibiotic therapy and its duration affect the onset of healthcare-associated infections (HAIs) sustained by MDR Klebsiella pneumoniae (MDR-Kp) in intensive care unit patients. Cases were defined as patients who developed an MDR-Kp HAI. Controls matched on sex and the length of intensive care unit (ICU) stay were randomly selected from the at-risk population. Any antibiotic agent received in systemic administration before the onset of infection was considered as antibiotic exposure. Multivariable conditional logistic regression analyses were performed to estimate the effect of prior exposure to each antibiotic class (Model 1) or its duration (Model 2) on the onset of HAIs sustained by MDR-Kp. Overall, 87 cases and 261 gender-matched controls were compared. In Model 1, aminoglycosides and linezolid independently increased the likelihood of developing an MDR-Kp HAI, whereas exposure to both linezolid and penicillins reduced the effect of linezolid alone. In Model 2, cumulative exposure to aminoglycosides increased the likelihood of the outcome, as well as cumulative exposures to penicillins and colistin, while a previous exposure to both penicillins and colistin reduced the influence of the two antibiotic classes alone. Our study confirms that aminoglycosides, penicillins, linezolid, and colistin may play a role in favoring the infections sustained by MDR-Kp. However, several double exposures in the time window before HAI onset seemed to hinder the selective pressure exerted by individual agents.

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Klebsiella pneumoniae acquisition in ICUs: patient-based and laboratory-based surveillance

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.714 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

M Barchitta ◽

A Maugeri ◽

C La Mastra ◽

MC La Rosa ◽

L Sessa ◽

...

Keyword(s):

Public Health ◽

Intensive Care ◽

High Risk ◽

Klebsiella Pneumoniae ◽

Intensive Care Units ◽

Multidrug Resistant ◽

Trauma Patients ◽

Healthcare Associated Infections ◽

Global Threat ◽

Healthcare Associated

Abstract Klebsiella pneumoniae - and especially multidrug-resistant K. pneumoniae - represents a global threat for Public Health, due to its high dissemination in Intensive Care Units (ICUs) and its association with mortality. Here, we investigated the molecular epidemiology of multidrug-resistant K. pneumoniae strains in ICUs from Catania, Italy. We used data and samples from the Italian Nosocomial Infections Surveillance in ICUs - SPIN-UTI project, which has been surveying the epidemiology and the risk of Healthcare-associated infections (HAIs) in Italian ICUs. The SPIN-UTI network adopted the ECDC protocols for patient-based HAI surveillance. In a sample of ICUs the patient-based surveillance was integrated with a laboratory-based surveillance of MDR K. pneumoniae isolates. K. pneumoniae isolates were genotyped by multilocus sequence typing (MLST), and patterns of K. pneumoniae acquisition (i.e. carriage, colonization and infection) were identified using standard definitions. Our analysis included 155 patients who stayed in two ICUs for a total of 2254 days, from October 2016 to March 2017. Trauma patients were more likely to be infected with K. pneumoniae than other patients (OR = 5.9; 95%CI=2.4-14.8; p = 0.004). A total of 109 K. pneumoniae strains were isolated from different sites of 39 patients, which in turn were defined as 45.2% colonization, 25.8% infection, and 29% carriage. 79.3% K. pneumoniae isolates resistant to carbapenems and 100% resistant to penicillins and cephalosporins. The MLST identified two major clonal groups: the ST395 and the ST37, which represented respectively the 65.6% and the 21.3% of typed isolates. Surveillance of colonization and infection by high-risk clones might help in implementing appropriate strategies, which are crucial to reduce the spread of K. pneumoniae in ICUs. *Study Group AOU 'Policlinico-Vittorio Emanuele', Catania, Italy: Patrizia Bellocchi, Giacomo Castiglione, Alida Imbriani, Marinella Astuto, Giuseppa La Camera, Agata Sciacca Key messages Multidrug-resistant K. pneumoniae still represents a threat for Public Health in Italy and globally, due to its high dissemination in intensive care units. Surveillance of colonization and infection by high-risk clones might help in reducing the spread of Klebsiella pneumoniae.

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Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Revista da Escola de Enfermagem da USP ◽

10.1590/s1980-220x2018001903474 ◽

2019 ◽

Vol 53 ◽

Cited By ~ 1

Author(s):

André Luiz Silva Alvim ◽

Bráulio Roberto Gonçalves Marinho Couto ◽

Andrea Gazzinelli

Keyword(s):

Klebsiella Pneumoniae ◽

Infection Control ◽

Hospital Environment ◽

Automated System ◽

Healthcare Associated Infections ◽

Klebsiella Pneumoniae Carbapenemase ◽

Hospital Infection Control ◽

Carbapenemase Gene ◽

Epidemiological Profile ◽

Healthcare Associated

ABSTRACT Objective: To study the epidemiological profile of Healthcare-associated Infections caused by Enterobacteria which carry the Klebsiella pneumoniae Carbapenemase gene (blaKPC) in the hospital environment. Method: A descriptive study was conducted in a private hospital in Belo Horizonte, MG, Brazil, which included all patients with infections caused by Enterobacteriaceae which carry the Klebsiella pneumoniae Carbapenemase gene. The data were collected by the Automated System of Hospital Infection Control and analyzed by descriptive statistics by the Epi Info 7 program. Results: Eighty-two (82) patients participated in the study. Klebsiella pneumoniae was the most frequent species (68%) isolated in blood (30%), bronchoalveolar lavage (22%) and urine (18%), while catheter-associated bloodstream infection (30%) predominated regarding topography. A case fatality rate of 62% is highlighted in evaluating the outcome. Conclusion: The resistance genes spread rapidly, limiting the antimicrobial options for treating infectious diseases. The epidemiological profile of Healthcare-Associated Infections found in this study can be prevented by prevention and infection control programs.

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Evolution and Epidemiology of Multidrug-Resistant Klebsiella pneumoniae in the United Kingdom and Ireland

mBio ◽

10.1128/mbio.01976-16 ◽

2017 ◽

Vol 8 (1) ◽

Cited By ~ 32

Author(s):

Danesh Moradigaravand ◽

Veronique Martin ◽

Sharon J. Peacock ◽

Julian Parkhill

Keyword(s):

United Kingdom ◽

Klebsiella Pneumoniae ◽

Large Scale ◽

Multidrug Resistant ◽

Antimicrobial Treatment ◽

Whole Genome ◽

The Past ◽

Healthcare Settings ◽

The United Kingdom ◽

Antimicrobial Resistance Genes

ABSTRACT Klebsiella pneumoniae is a human commensal and opportunistic pathogen that has become a leading causative agent of hospital-based infections over the past few decades. The emergence and global expansion of hypervirulent and multidrug-resistant (MDR) clones of K. pneumoniae have been increasingly reported in community-acquired and nosocomial infections. Despite this, the population genomics and epidemiology of MDR K. pneumoniae at the national level are still poorly understood. To obtain insights into these, we analyzed a systematic large-scale collection of invasive MDR K. pneumoniae isolates from hospitals across the United Kingdom and Ireland. Using whole-genome phylogenetic analysis, we placed these in the context of previously sequenced K. pneumoniae populations from geographically diverse countries and identified their virulence and drug resistance determinants. Our results demonstrate that United Kingdom and Ireland MDR isolates are a highly diverse population drawn from across the global phylogenetic tree of K. pneumoniae and represent multiple recent international introductions that are mainly from Europe but in some cases from more distant countries. In addition, we identified novel genetic determinants underlying resistance to beta-lactams, gentamicin, ciprofloxacin, and tetracyclines, indicating that both increased virulence and resistance have emerged independently multiple times throughout the population. Our data show that MDR K. pneumoniae isolates in the United Kingdom and Ireland have multiple distinct origins and appear to be part of a globally circulating K. pneumoniae population. IMPORTANCE Klebsiella pneumoniae is a major human pathogen that has been implicated in infections in healthcare settings over the past few decades. Antimicrobial treatment of K. pneumoniae infections has become increasingly difficult as a consequence of the emergence and spread of strains that are resistant to multiple antimicrobials. To better understand the spread of resistant K. pneumoniae, we studied the genomes of a large-scale population of extensively antimicrobial-resistant K. pneumoniae in the United Kingdom and Ireland by utilizing the fine resolution that whole-genome sequencing of pathogen genomes provides. Our results indicate that the K. pneumoniae population is highly diverse and that, in some cases, resistant strains appear to have spread across the country over a few years. In addition, we found evidence that some strains have acquired antimicrobial resistance genes independently, presumably in response to antimicrobial treatment. IMPORTANCE Klebsiella pneumoniae is a major human pathogen that has been implicated in infections in healthcare settings over the past few decades. Antimicrobial treatment of K. pneumoniae infections has become increasingly difficult as a consequence of the emergence and spread of strains that are resistant to multiple antimicrobials. To better understand the spread of resistant K. pneumoniae, we studied the genomes of a large-scale population of extensively antimicrobial-resistant K. pneumoniae in the United Kingdom and Ireland by utilizing the fine resolution that whole-genome sequencing of pathogen genomes provides. Our results indicate that the K. pneumoniae population is highly diverse and that, in some cases, resistant strains appear to have spread across the country over a few years. In addition, we found evidence that some strains have acquired antimicrobial resistance genes independently, presumably in response to antimicrobial treatment.

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Using Whole Genome Sequencing to Investigate a Mock-Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Real-Time

Acta Médica Portuguesa ◽

10.20344/amp.15174 ◽

2021 ◽

Vol 34 (13) ◽

Author(s):

Alexandra Sofia Simões ◽

Tiago Touret ◽

Nuno Alexandre Faria ◽

Susana Peres Ladeiro ◽

João Costa ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Infection Control ◽

Whole Genome Sequencing ◽

Genome Sequencing ◽

Environmental Samples ◽

Clinical Isolates ◽

Whole Genome ◽

Healthcare Associated Infections ◽

Carbapenem Resistant ◽

Healthcare Associated

Introduction: Healthcare associated infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) are a major concern in Portuguese hospitals. Whole genome sequencing (WGS) can improve infection control, but this practice is not routinely used by hospital clinical laboratories in Portugal. We simulated the investigation of a CRKP outbreak based on WGS, with the aim of determining, in the minimum possible time, genetic relatedness between CRKP clinical and environmental isolates.Material and Methods: Ten CRKP clinical isolates routinely obtained in the hospital laboratory were used. Forty environmental samples - from sinks and sink drains of ward rooms - were collected. Environmental samples were plated on selective media and presumptive CRKP colonies were isolated. Total DNA was extracted from all putative CRKP isolates and sequenced. Clonal relatedness was determined by multi-locus sequence typing and core genome single nucleotide polymorphism analysis; the presence of carbapenemase genes was evaluated.Results: Clinical isolates were characterized in 48 hours: eight strains were confirmed as CRKP, of which six were of ST13 and carried blaKPC-3. Environmental samples results were obtained in six days: eight CRKP were isolated from which five were of ST13 and carried blaKPC-3. Clinical and environmental ST13 isolates were highly related: ten (of 11) isolates differed from each other in < 0.001% of 2 172 367 core nucleotides.Discussion: WGS can be used as a high-resolution effective tool to investigate healthcare associated infections and track routes of dissemination in real-time.Conclusion: In Portugal, routine use of WGS to improve infection control could thrive through collaborative initiatives between hospitals and research institutes.

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Multidrug Resistance among Gram-Negative Pathogens That Caused Healthcare-Associated Infections Reported to the National Healthcare Safety Network, 2006–2008

Infection Control and Hospital Epidemiology ◽

10.1086/652152 ◽

2010 ◽

Vol 31 (05) ◽

pp. 528-531 ◽

Cited By ~ 96

Author(s):

Alexander J. Kallen ◽

Alicia I. Hidron ◽

Jean Patel ◽

Arjun Srinivasan

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistance ◽

Klebsiella Pneumoniae ◽

Acinetobacter Baumannii ◽

Multidrug Resistant ◽

Healthcare Associated Infections ◽

Gram Negative ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Healthcare Associated

We evaluated isolates of Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii that were reported to the National Healthcare Safety Network from January 2006 through December 2008 to determine the proportion that represented multidrug-resistant phenotypes. The pooled mean percentage of resistance varied by the definition used; however, multidrug resistance was relatively common and widespread.

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Recent advances in the understanding and management of Klebsiella pneumoniae

F1000Research ◽

10.12688/f1000research.11532.1 ◽

2017 ◽

Vol 6 ◽

pp. 1760 ◽

Cited By ~ 12

Author(s):

David P. Calfee

Keyword(s):

Klebsiella Pneumoniae ◽

Multidrug Resistant ◽

Health Concern ◽

Patient Specific ◽

Healthcare Associated Infections ◽

Emerging Pathogens ◽

Resistant Strains ◽

Poor Outcomes ◽

Optimal Approach ◽

Healthcare Associated

Klebsiella pneumoniae, a gram-negative bacillus of the Enterobacteriaceae family, is a component of the normal human microbiota and a common cause of community- and healthcare-associated infections. The increasing prevalence of antimicrobial resistance among K. pneumoniae isolates, particularly among those causing healthcare-associated infections, is an important public health concern. Infections caused by these multidrug-resistant organisms, for which safe and effective antimicrobial therapy options are extremely limited, are associated with poor outcomes for patients. The optimal approach to the treatment of infections caused by these multidrug-resistant strains remains undefined, and treatment decisions for an individual patient should be based on a number of organism- (for example, minimum inhibitory concentration) and patient-specific (for example, site of infection) factors. The emergence of pandrug-resistant strains of K. pneumoniae highlights the critical need for consistent implementation of effective strategies for prevention of transmission and infection and for the development of new antimicrobials with activity against these emerging pathogens.

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The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Multidrug-Resistant Organisms

Infection Control and Hospital Epidemiology ◽

10.1086/656001 ◽

2010 ◽

Vol 31 (S1) ◽

pp. S18-S21 ◽

Cited By ~ 10

Author(s):

Aaron M. Milstone ◽

Kristina A. Bryant ◽

W. Charles Huskins ◽

Danielle M. Zerr

Keyword(s):

Hospital Stay ◽

Infection Prevention ◽

Multidrug Resistant ◽

Healthcare Associated Infections ◽

Healthcare Associated Infection ◽

Research Topics ◽

The Past ◽

Multidrug Resistant Organisms ◽

Healthcare Associated

Multidrug resistant organisms (MDROs) and healthcare-associated infections (HAIs) are associated with increased lengths of hospital stay, increased costs, and increased mortality. We explore the scope of MDRO HAIs in children, current MDRO HAI prevention practices and data to support these practices, and we propose research topics targeting MDRO HAI prevention in children.

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Infection control teams for reducing healthcare-associated infections in hospitals and other healthcare settings: a protocol for systematic review

BMJ Open ◽

10.1136/bmjopen-2020-044971 ◽

2021 ◽

Vol 11 (3) ◽

pp. e044971

Author(s):

Moe Moe Thandar ◽

Sadatoshi Matsuoka ◽

Obaidur Rahman ◽

Erika Ota ◽

Toshiaki Baba

Keyword(s):

Systematic Review ◽

Infection Control ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Well Being ◽

Risk Of Bias ◽

Cochrane Library ◽

Healthcare Associated Infections ◽

Healthcare Settings ◽

Healthcare Associated

IntroductionHealthcare-associated infections (HCAIs) are a worldwide problem. Infection control in hospitals is usually implemented by an infection control team (ICT). Initially, ICTs consisted of doctors, nurses, epidemiologists and microbiologists; then, in the 1980s, the infection control link nurse (ICLN) system was introduced. ICTs (with or without the ICLN system) work to ensure the health and well-being of patients and healthcare professionals in hospitals and other healthcare settings, such as acute care clinics, community health centres and care homes. No previous study has reported the effects of ICTs on HCAIs. This systematic review aims to assess the effectiveness of ICTs with or without the ICLN system in reducing HCAIs in hospitals and other healthcare settings.Methods and analysisWe will perform a comprehensive literature search for randomised controlled trials in four databases: PubMed, Embase, CINAHL and the Cochrane Library. The primary outcomes are: patient-based/clinical outcomes (rate of HCAIs, death due to HCAIs and length of hospital stay) and staff-based/behavioural outcomes (compliance with infection control practices). The secondary outcomes include the costs to the healthcare system or patients due to extended lengths of stay. Following data extraction, we will assess the risk of bias by using the Cochrane Effective Practice and Organization of Care risk of bias tool. If data can be pooled across all the studies, we will perform a meta-analysis.Ethics and disseminationWe will use publicly available data, and therefore, ethical approval is not required for this systematic review. The findings will be submitted for publication in peer-reviewed journals.Trial registration numberCRD42020172173.

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