Novel carbapenemhydrolyzing betalactamase, kpc1, from a carbapenem resistant strain of klebsiella pneumoniae. We aimed to evaluate the clinical impact of such a regimen in critically ill patients. We describe an outbreak of klebsiella pneumoniae carbapenemase kpcproducing klebsiella pneumoniae kpckp st258 that occurred in two institutions a hospital and a nursing home in the netherlands between july and december 20. We report the first outbreak of klebsiella pneumoniae carbapenemase kpcproducing k. Seven different species were identified from the nine vimproducing isolates. Stepwise evolution of pandrugresistance in klebsiella. Carbapenemresistant klebsiella pneumoniae associated with. Resolution of carbapenemaseproducing klebsiella pneumoniae outbreak in a tertiary cancer center. Molecular epidemiology of a large outbreak of multiplyresistant klebsiella pneumoniae. Introduction to klebsiella pneumoniae carbapenemases. Multiple variants of klebsiella pneumoniae producing carbapenemase in one patient in this report, the diversity of carbapenemresistant bacteria in a single patient over several years is investigated. Clinical isolates classified by multilocus sequence typing st as st258 are the most widespread.
Polymerase chain reaction assays were performed to detect the bla kpc gene and molecular typing was performed using pulsedfield gel electrophoresis pfge. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and. Enzymemediated carbapenem resistance in enterobacteriaceae is relatively rare. Outbreak of klebsiella pneumoniae carbapenemaseproducing klebsiella. Curless, maggie cantara, seema mehta, kristen marrone, karen c carroll, patricia simner, lisa maragakis. The mortality described among patients infected with organisms positive for kpc is high, perhaps as a. On august 16, 2012, the colorado department of public health and environment was notified of two patients at an acutecare hospital in denver with carbapenemresistant enterobacteriaceae cre, specifically klebsiella. Carbapenems, such as imipenem and meropenem, are often used to treat infections caused by extendedspectrum betalactamase esblproducing. Outbreak of carbapenemresistant klebsiella pneumoniae in puerto. Surveillance and outbreak reports carbapenemaseproducing.
However, clinically relevant carbapenemases belong to three of these classes, namely class a betalactamases such as klebsiella pneumoniae carbapenemase kpc and guiana extendedspectrum carbapenemase ges, class b metallobetalactamases such as verona integronmediated metallobetalactamase vim, imipenemase imp and new delhi metalloplactamase ndm, and class d. Vim was the most commonly identified carbapenemase after klebsiella pneumoniae carbapenemase. Outbreak of klebsiella pneumoniae carbapenemaseproducing. An outbreak of multiplyresistantklebsiella pneumoniaein the grampian region of scotland. Treatment of klebsiella pneumoniae carbapenemaseproducing. Nosocomial outbreak of klebsiella pneumoniae carbapenemase. Hayden, karen lolans, sarah won, karen calvert, michael lin, alexander sterner, robert a. The successful proliferation, transmission and infection of the gramnegative bacterium can be attributed to a myriad of factors including host factors, environmental factors. No carbapenem resistance in pneumonia caused by klebsiella species.
On january 27, 2011, a west virginia county health department was notified of a cluster of carbapenemresistant klebsiella pneumoniae crkp cases detected by a local hospital hospital a. Tracking a hospital outbreak of carbapenemresistant. Carbapenemresistant klebsiella pneumoniae has emerged globally as a multidrugresistant hospital pathogen for which there are few treatment options. Typing was performed by pulsedfield gel electrophoresis pfge. Klebsiella pneumoniae is a gramnegative, nonmotile, encapsulated, lactosefermenting, facultative anaerobic, rodshaped bacterium. The real threat of klebsiella pneumoniae carbapenemaseproducing bacteria patrice nordmann, gaelle cuzon, thierry naas from early this decade, enterobacteriaceae that produce klebsiella pneumoniae carbapenemases kpc were reported in the usa and subsequently worldwide. The increasing incidence of carbapenemresistant klebsiella pneumoniae crkp fundamentally alters the management of patients at risk to be colonized or infected by such microorganisms. Outbreak of carbapenem resistant klebsiella pneumoniae. Detection of carbapenemresistant klebsiella pneumoniae. Pseudomonas aeruginosa atcc 27853, escherichia coli atcc 25922, e. Outbreak of carbapenemresistant klebsiella pneumoniae in puerto rico associated with a novel carbapenemase variant. The kpcencoding plasmid was analysed by transconjugation experiments, dna sequencing, southern blotting and isoelectric focussing.
Hospital outbreak of carbapenemresistant klebsiella pneumoniae producing new delhi metallobetalactamase denver, colorado, 2012. Outbreak of klebsiella pneumoniae carbapenemaseproducing citrobacter freundii at a tertiary acute care facility in miami, florida. Outbreak of carbapenemresistant klebsiella pneumoniae two. An outbreak of klebsiella pneumoniae carbapenemase in 2014 demonstrated there. In total, six patients were found to be positive for kpckp. During the past decade, enterobacteria that produce klebsiella pneumoniae carbapenemase kpc have become established in the united states and countries in south america and europe. In asia, kpc was reported in the peoples republic of china in 2007 and subsequently in south korea and taiwan. Successful control of an outbreak of klebsiella pneumoniae. Outbreak of carbapenemresistant klebsiella pneumoniae infection in an acute care hospital charlotte county bureau of epidemiology grand rounds presentation september 24, 20 division of disease control and health protection. This study describes a carbapenemresistant klebsiella pneumoniae crkp outbreak that occurred from october 2008december 2010. The first outbreak of kpcproducing k pneumoniae outside the usa was. First outbreak of klebsiella pneumoniae carbapenemase kpc.
The bacteria produce an enzyme called klebsiella pneumoniae carbapenemase that makes a range of antibiotics ineffective, including betalactams, penicillins, and cephalosporins. Crkp infections frequently are resistant to a majority of antimicrobial agents and have. Carbapenemresistant klebsiella pneumoniae associated with a longtermcare facility west virginia, 20092011. Klebsiella pneumoniae carbapenemases kpcs were originally identified in the usa in 1996. Over the past 10 years, dissemination of klebsiella pneumoniae carbapenemase kpc has led to an increase in the prevalence of carbapenemresistant enterobacteriaceae cre in the united states. Klebsiella pneumoniae carbapenemase kpc enzymes are ambler class a carbapenemases that were. Risk factors and clinical impact of klebsiella pneumoniae. Most isolates showed a multidrugresistance phenotype. An outbreak of colistinresistant klebsiella pneumoniae. The presence of kpc was confirmed by polymerase chain reaction pcr. These kpcproducing bacteria are predominantly involved in nosocomial. Primers used in study of new delhi metallo lactamase in klebsiella pneumoniae and escherichia coli, canada, 2010 name sequence, 5 o 3 product size, bp.
This agent has demonstrated activity against resistant gramnegative bacteria, including klebsiella pneumoniae carbapenemaseproducing organisms. Spread of klebsiella pneumoniae carbapenemaseproducing k. Recent reports have suggested the efficacy of a double carbapenem dc combination, including ertapenem, for the treatment of carbapenemresistant klebsiella pneumoniae crkp infections. Public health agencies emphasize screening and strict contact precautions to. Outbreak of carbapenemresistant klebsiella pneumoniae in. One particularly dangerous bug, klebsiella pneumoniae carbapenemase, or kpc, has been found in american hospitals in 44 states so far. Klebsiella pneumoniae is a nosocomial pathogen commonly implicated in hospital outbreaks with a propensity for antimicrobial resistance towards mainstay. Recommendations for the control of carbapenemaseproducing.
On june 2011, patient 1 was transferred to our icu from a hospital in new york city and was discharged on 15 july. Molecular dissection of the evolution of carbapenem. Outbreak of carbapenemresistant klebsiella pneumoniae. Pdf klebsiella pneumoniae carbapenemase kpcproducing.
The real threat of klebsiella pneumoniae carbapenemase. However, klebsiella pneumoniae carbapenemase kpc type. Klebsiella strains that produce extendedspectrum betalactamase esbl may develop resistance to cephalosporins during treatment, particularly with ceftazidime. The change in the type of carbapenemase further reduces. However, it would be a mistake to think that the bacteria have been completely eradicated from the facility. Emergence of a carbapenem resistant klebsiella pneumoniae. The basis for the success of st258 organisms above and beyond antibiotic resistance is not known, nor is it clear whether infections are. Lithuania reported an outbreak of carbapenemresistant, and for some cases. Multiple variants of klebsiella pneumoniae producing. For example, epidemics of vimproducing carbapenem resistant k. Carbapenemresistant klebsiella pneumoniae european. Successful control of an outbreak of klebsiella pneumoniae carbapenemaseproducing k. It appears as a mucoid lactose fermenter on macconkey agar although found in the normal flora of the mouth, skin, and intestines, it can cause destructive changes to human and animal lungs if aspirated, specifically to the alveoli resulting in bloody, brownish.
Caesar and earsnet collect susceptibility test results of invasive isolates from national amr surveillance networks. Double carbapenem as a rescue strategy for the treatment. Klebsiella pneumoniae carbapenemase synonyms, klebsiella pneumoniae carbapenemase pronunciation, klebsiella pneumoniae carbapenemase translation, english dictionary definition of klebsiella pneumoniae carbapenemase. Network laboratories are asked to report antimicrobial susceptibility results for the first isolate from blood or cerebrospinal fluid csf per patient per year. Treatment of carbapenemresistant klebsiella pneumoniae. They are categorized as ambler class a and bush functional group 2f. Outbreak of carbapenemresistant klebsiella pneumoniae in puerto rico associated with a novel carbapenemase variant article pdf available in infection control and.
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