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.

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

scholarly journals Spread of Multi-Antibiotic-Resistant Health-Care Pathogens in Hospitals to Treat COVID-19 Patients

2021 ◽  
Vol 20 (2) ◽  
pp. 68-73
Author(s):  
A. E. Goncharov ◽  
L. P. Zueva ◽  
A. S. Mokhov ◽  
V. V. Kolodzhieva ◽  
A. A. Meltser ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Respiratory Tract ◽  
Acinetobacter Baumannii ◽  
Nosocomial Infections ◽  
Molecular Typing ◽  
Molecular Genetic ◽  
Wide Distribution ◽  
Control Measures ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene

Relevance. The COVID-19 pandemic has led to significant overloads in the work of health systems in many countries, a shortage of beds and staff, which contributes to a decrease in adherence to measures to prevent and control nosocomial infections, which can significantly worsen the course of viral pneumonia. Aim. To assess the possibility of the formation of hospital strains of multidrugresistant microorganisms in hospitals repurposed to provide medical care to patients with COVID-19. Materials and methods. The study included patients with severe and moderate forms of COVID-19 (ICD codes U07.1, U07.2), who were admitted to two large hospitals repurposed for the treatment of this infection. The data of microbiological studies of the biomaterial associated with the respiratory tract (sputum, bronchoalveolar lavage, tracheal aspirates) obtained from 1101 patients from May to January 2021 were analyzed using a combination of molecular genetic methods (RAPD-PCR, detection of integrons and the carbapenemase gene bla NDM.), and molecular typing of carbapenem-resistant strains of Klebsiella pneumoniae and Acinetobacter baumannii was carried out. Results. It was found that carbapenem resistant gram-negative bacteria predominate in the structure of the nosocomial microbiota of the respiratory tract of patients with COVID-19 in both hospitals. Based on molecular typing made the wide distribution of several genetic lines of integron-positive carbapenem resistant Klebsiella pneumoniae and Acinetobacter baumannii was detected. Conclusions. The COVID-19 pandemic has exacerbated the spread and circulation of bacteria with multiple antibiotic resistance in hospitals. This study has demonstrated the possibility of the formation of hospital strains of nosocomial infections in COVID-19 hospitals, which justifies the need to improve infection control measures in the context of a new coronavirus infection pandemic.

scholarly journals Enterobacteriaceae isolates carrying the New Delhi metallo-β-lactamase gene in Yemen

2014 ◽  
Vol 63 (10) ◽  
pp. 1316-1323 ◽  
Author(s):  
Alima Gharout-Sait ◽  
Samer-Ahmed Alsharapy ◽  
Lucien Brasme ◽  
Abdelaziz Touati ◽  
Rachida Kermas ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Susceptibility Testing ◽  
Enterobacter Cloacae ◽  
New Delhi ◽  
Carbapenem Resistant ◽  
Genes Encoding ◽  
Phenotypic Tests ◽  
Lactamase Gene ◽  
Sequence Types

Ten carbapenem-resistant Enterobacteriaceae (eight Klebsiella pneumoniae isolates and two Enterobacter cloacae) isolates from Yemen were investigated using in vitro antimicrobial susceptibility testing, phenotypic carbapenemase detection, multilocus sequence typing (MLST) and replicon typing. Carbapenemase, extended-spectrum β-lactamase (ESBL) and plasmid-mediated quinolone resistance determinant genes were identified using PCR and sequencing. All of the 10 carbapenem-resistant Enterobacteriaceae were resistant to β-lactams, tobramycin, ciprofloxacin and cotrimoxazole. Imipenem, doripenem and meropenem MICs ranged from 2 to >32 mg l−1 and ertapenem MICs ranged from 6 to >32 mg l−1. All of the K. pneumoniae isolates showed ESBL activity in phenotypic tests. Genes encoding bla NDM were detected in all strains. All K. pneumoniae strains produced CTX-M-15 ESBL and SHV β-lactamases. TEM-1 β-lactamase was detected in seven isolates. Nine isolates were qnr positive including QnrB1, QnrA1 and QnrS1, and six isolates produced AAC-6′-Ib-cr. MLST identified five different sequence types (STs): ST1399, ST147, ST29, ST405 and ST340. Replicon typing showed the presence of IncFII1K plasmids in four transformants. To the best of our knowledge, this is the first report of NDM-1-producing Enterobacteriaceae isolates in Yemen.

scholarly journals Duodenoscope-Associated Outbreak of a Carbapenem Resistant Enterobacteriaceae

2020 ◽  
Vol 41 (S1) ◽  
pp. s197-s197
Author(s):  
Sung Ran Kim ◽  
Joon Young Song ◽  
Min Hee Cho ◽  
Ji Yeon Song
Keyword(s):  
Gel Electrophoresis ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Analysis ◽  
Endoscopic Retrograde ◽  
Carbapenem Resistant ◽  
Case Control Analysis ◽  
Record Review ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Cleaning Protocol

Background: We describe and evaluate our outbreak of carbapenem-resistant K. pneumoniae transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: An outbreak investigation was performed when Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) were identified from bile specimens of 4 patients. The investigation included medical record review, practice audits, and surveillance cultures of duodenoscopes and environmental sites. If available, clinical specimens were obtained from patients who had undergone ERCP in the previous 3 months. Carbapenem-resistant Enterobacteriaceae (CRE) screening cultures were performed to identify additional patients until no CRE cases were detected during 2 consecutive weeks. Pulsed-field gel electrophoresis (PFGE) of KPC-KP isolates was implemented. Results: In total, 12 cases were identified with exposure to duodenoscope from February 2019 through April 2019, including 6 cases with infections and 6 asymptomatic carriers. Case-control analysis showed that 2 specific duodenoscopes would be associated with the KPC-KP outbreak. Duodenoscope reprocessing procedures did not deviate from manufacturer recommendations for reprocessing. After ethylene oxide (EO) gas sterilization, the outbreak was terminated. Conclusions: Meticulous cleaning protocol and enhanced surveillance are necessary to prevent outbreaks of CRE. Notably, enhanced cleaning measures, such as sterilization for duodenoscopes, would be required after procedures with KPC-KP carriers.Funding: NoneDisclosures: None

scholarly journals Spread of Carbapenemase Producing Klebsiella pneumoniae Isolates in Our Hospital: Investigation of Molecular Typing and Clonal Relationship

2021 ◽  
Author(s):  
Reyhan Kiş ◽  
Ebru Demiray Gündüz ◽  
Ayşe Nur Sarı ◽  
Zeynep Gülay
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Hospital Staff ◽  
Control Measures ◽  
Automated System ◽  
Microbiology Laboratory ◽  
Clonal Relationship ◽  
Infection Control Measures ◽  
Carbapenem Resistant

Objective: Carbapenem resistance has been reported with increasing frequency among members of Enterobacterales, especially in the last 10 years. Screening and detection of carbapenemase-producing isolates is important in terms of both directing the treatment and preventing its spread. In our study, it was aimed to determine the carbapenemase types and molecular epidemiological relationships of carbapenem resistant Klebsiella pneumoniae isolates, which were isolated sequentially from the samples sent to microbiology laboratory of our hospital. Method: A total of 32 carbapenem-resistant K. pneumoniae isolates of the samples sent to microbiology laboratory between July and September 2014, were included in the study. In addition to classical methods, identification of isolates at species level was made with BD Phoenix ID/AST automated system. Carbapenemase types (blaOXA-48, blaNDM, blaIMP, blaKPC, blaVIM and blaGES) of the isolates were investigated by PCR. The clonal relationship between the isolates was assessed with PFGE. Results: It was noted that 18 isolates were obtained from intensive care units, 9 from inpatient and 5 from outpatient departments. The blaOXA48 gene was found in all isolates while the other carbapenemase genes were not found. It was determined that strains were isolated from 32 patients in our hospital had 12 different PFGE pulsotypes, named as A-L. Among these, the most common ones were B (n=18) and closely related B1 pattern (n=2). The remaining isolates were represented by 11 different types. It was observed that the first isolate with B pulsotype was responsible for the spread of the outbreak from General Intensive Care Unit. Conclusion: It has been thought that the spread of carbapenem- resistant K. pneumoniae isolates in the hospital was probably occurred through the transfer of isolates from patients with gastrointestinal colonization to other patients through hospital staff. Therefore, the spread of the isolates in hospitals can be limited by detecting colonization with active surveillance programs and by applying contact isolation and effective infection control measures.

scholarly journals Use of Next Generation Sequencing and Synergy Susceptibility Testing in Diagnosis and Treatment of Carbapenem-Resistant Klebsiella pneumoniae Blood Stream Infection

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yuetian Yu ◽  
Fupin Hu ◽  
Cheng Zhu ◽  
Erzhen Chen ◽  
Liangjing Lu ◽  
...  
Keyword(s):  
Next Generation Sequencing ◽  
Klebsiella Pneumoniae ◽  
Lupus Erythematosus ◽  
Susceptibility Testing ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
Next Generation ◽  
Carbapenem Resistant ◽  
Appropriate Treatment ◽  
Generation Sequencing

Early diagnosis and appropriate treatment for carbapenem-resistant Klebsiella pneumoniae (CR-Kp) infection is a big challenge for clinicians due to its high mortality. Every effort has been made to improve its clinical outcomes. However, treatment according to synergy susceptibility testing has never been reported in the literature. We reported a 29-year-old systemic lupus erythematosus female with CR-Kp blood stream infection. We highlighted the identification by next generation sequencing and treatment according to synergy susceptibility testing in the case.

The epidemiology, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit from 2012 to 2018

2020 ◽  
Author(s):  
Ping Wang ◽  
Xiaocui Zou ◽  
Boting Zhou ◽  
Tao Yin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Incidence And Mortality ◽  
Changing Trend ◽  
Different Sources

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing globally threat for human health, but the trends and clinical characteristics of CRKP infections in the intensive care unit(ICU) remain uninvestigated.Methods: A retrospective study was conducted among ICU patients infected with KP isolates from January 2012 to December 2018. Carbapenem resistant to Klebsiella pneumoniae was defined according to Clinical and Laboratory Standards Institute (CLSI) criteria. The incidence and changing trend of CRKP were determined. CRKP patient sources, specimen types, infection sources and outcomes were investigated. Results: There were 256(40.13%) patients with CRKP and 382(59.87%) patients with CSKP. The incidence of CRKP increased from 2012(11.11%) to 2017(63.48%) and decreased in 2018(51.52%). The proportion of isolates not susceptible to three carbapenems increased from 0 to 98.04%. The rates of CRKP isolated from blood, wound, urine and pleural fluid were higher than that of CSKP. CRKP infections were mainly ICU acquired, rather than input acquired. Conclusion: The incidence of CRKP was high in ICU, but showed a downward trend. Implementation of different infection control measures to different sources of patients, specimen types, and KP infections are necessary. Surveillance data will be needed for ICU patients to decrease the incidence and mortality of CRKP.

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