Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant

Christopher J. Gregory, Eloisa Llata, Nicholas Stine, Carolyn Gould, Luis Manuel Santiago, Guillermo J. Vazquez, Iraida E. Robledo, Arjun Srinivasan, Richard V. Goering, Kay M. Tomashek

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

background. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality. objective. To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak. design. Two case-control studies. setting. A 328-bed tertiary care teaching hospital. patients. Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period. methods. We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the bla KPC gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis. results. In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak. conclusions. Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.

Original languageEnglish
Pages (from-to)476-484
Number of pages9
JournalInfection Control and Hospital Epidemiology
Volume31
Issue number5
DOIs
StatePublished - May 1 2010

Fingerprint

Puerto Rico
Carbapenems
Klebsiella pneumoniae
Disease Outbreaks
Confidence Intervals
Odds Ratio
carbapenemase
Klebsiella Infections
Pulsed Field Gel Electrophoresis
Wounds and Injuries
Tertiary Healthcare
Infection Control
Anti-Infective Agents
Microbiology
Teaching Hospitals

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Epidemiology
  • Infectious Diseases

Cite this

Gregory, C. J., Llata, E., Stine, N., Gould, C., Santiago, L. M., Vazquez, G. J., ... Tomashek, K. M. (2010). Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant. Infection Control and Hospital Epidemiology, 31(5), 476-484. https://doi.org/10.1086/651670

Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant. / Gregory, Christopher J.; Llata, Eloisa; Stine, Nicholas; Gould, Carolyn; Santiago, Luis Manuel; Vazquez, Guillermo J.; Robledo, Iraida E.; Srinivasan, Arjun; Goering, Richard V.; Tomashek, Kay M.

In: Infection Control and Hospital Epidemiology, Vol. 31, No. 5, 01.05.2010, p. 476-484.

Research output: Contribution to journalArticle

Gregory, CJ, Llata, E, Stine, N, Gould, C, Santiago, LM, Vazquez, GJ, Robledo, IE, Srinivasan, A, Goering, RV & Tomashek, KM 2010, 'Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant', Infection Control and Hospital Epidemiology, vol. 31, no. 5, pp. 476-484. https://doi.org/10.1086/651670
Gregory, Christopher J. ; Llata, Eloisa ; Stine, Nicholas ; Gould, Carolyn ; Santiago, Luis Manuel ; Vazquez, Guillermo J. ; Robledo, Iraida E. ; Srinivasan, Arjun ; Goering, Richard V. ; Tomashek, Kay M. / Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant. In: Infection Control and Hospital Epidemiology. 2010 ; Vol. 31, No. 5. pp. 476-484.
@article{bc7d97836b03432f909337f03540244a,
title = "Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant",
abstract = "background. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality. objective. To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak. design. Two case-control studies. setting. A 328-bed tertiary care teaching hospital. patients. Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period. methods. We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the bla KPC gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis. results. In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95{\%} confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95{\%} CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95{\%} CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95{\%} CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak. conclusions. Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.",
author = "Gregory, {Christopher J.} and Eloisa Llata and Nicholas Stine and Carolyn Gould and Santiago, {Luis Manuel} and Vazquez, {Guillermo J.} and Robledo, {Iraida E.} and Arjun Srinivasan and Goering, {Richard V.} and Tomashek, {Kay M.}",
year = "2010",
month = "5",
day = "1",
doi = "10.1086/651670",
language = "English",
volume = "31",
pages = "476--484",
journal = "Infection Control and Hospital Epidemiology",
issn = "0899-823X",
publisher = "University of Chicago Press",
number = "5",

}

TY - JOUR

T1 - Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant

AU - Gregory, Christopher J.

AU - Llata, Eloisa

AU - Stine, Nicholas

AU - Gould, Carolyn

AU - Santiago, Luis Manuel

AU - Vazquez, Guillermo J.

AU - Robledo, Iraida E.

AU - Srinivasan, Arjun

AU - Goering, Richard V.

AU - Tomashek, Kay M.

PY - 2010/5/1

Y1 - 2010/5/1

N2 - background. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality. objective. To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak. design. Two case-control studies. setting. A 328-bed tertiary care teaching hospital. patients. Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period. methods. We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the bla KPC gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis. results. In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak. conclusions. Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.

AB - background. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality. objective. To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak. design. Two case-control studies. setting. A 328-bed tertiary care teaching hospital. patients. Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period. methods. We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the bla KPC gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis. results. In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak. conclusions. Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.

UR - http://www.scopus.com/inward/record.url?scp=77951045230&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77951045230&partnerID=8YFLogxK

U2 - 10.1086/651670

DO - 10.1086/651670

M3 - Article

VL - 31

SP - 476

EP - 484

JO - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

SN - 0899-823X

IS - 5

ER -