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Long-term carriage of Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae after a large single-center outbreak in Germany.
Am J Infect Control. 2014 Apr; 42(4):376-80.AJ

Abstract

BACKGROUND

The natural progress of intestinal colonization with Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae (KPC-2-KP) is almost unknown.

METHODS

After a large, single-center outbreak of KPC-2-KP, we analyzed carrier prevalence through retrospective and prospective investigation of intestinal KPC-2-KP carriage 1 month, 3 months, 6 months, 1 year, and 2 years after acquisition, defined as the earliest date of KPC-2-KP detection. Rectal swabs or stool samples were collected at baseline and at each visit and submitted for both culture and KPC-specific polymerase chain reaction. Resolution of intestinal KPC-2-KP carriage was defined as a minimum of 3 consecutive negative polymerase chain reaction test results separated by at least 48 hours.

RESULTS

In patients available for long-term evaluation 26 out of 84 patients (31%) tested negative for KPC-2-KP after 1 month, 14 out of 34 (41%) after 3 months, 17 out of 26 (65%) after 6 months, 14 out of 19 (74%) after 1 year, and 5 out of 6 (83%) after 2 years. Decolonization of KPC-2-KP was hampered in patients with prolonged or repeated hospitalization (P = .044-.140, depending on the time interval). Two patients retested positive for KPC-2-KP after they had previously shown 3 consecutive negative tests. The longest positive KPC-2-KP carrier status so far was observed after nearly 40 months (1,191 days).

CONCLUSIONS

The majority of patients experienced spontaneous decolonization within 6 months after acquisition, mainly after discharge from the hospital. However, long-term carriage of >3 years is possible. Appropriate infection control measures must be taken when these patients are readmitted to health care facilities. A series of at least 4 consecutive negative rectal swabs or stool samples separated by sufficient time intervals appears necessary before the declaration of successful KPC-2-KP decolonization is made.

Authors+Show Affiliations

Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany. Electronic address: christoph.luebbert@medizin.uni-leipzig.de.Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany.Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany.Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany.Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24679563

Citation

Lübbert, Christoph, et al. "Long-term Carriage of Klebsiella Pneumoniae Carbapenemase-2-producing K Pneumoniae After a Large Single-center Outbreak in Germany." American Journal of Infection Control, vol. 42, no. 4, 2014, pp. 376-80.
Lübbert C, Lippmann N, Busch T, et al. Long-term carriage of Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae after a large single-center outbreak in Germany. Am J Infect Control. 2014;42(4):376-80.
Lübbert, C., Lippmann, N., Busch, T., Kaisers, U. X., Ducomble, T., Eckmanns, T., & Rodloff, A. C. (2014). Long-term carriage of Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae after a large single-center outbreak in Germany. American Journal of Infection Control, 42(4), 376-80. https://doi.org/10.1016/j.ajic.2013.12.001
Lübbert C, et al. Long-term Carriage of Klebsiella Pneumoniae Carbapenemase-2-producing K Pneumoniae After a Large Single-center Outbreak in Germany. Am J Infect Control. 2014;42(4):376-80. PubMed PMID: 24679563.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-term carriage of Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae after a large single-center outbreak in Germany. AU - Lübbert,Christoph, AU - Lippmann,Norman, AU - Busch,Thilo, AU - Kaisers,Udo X, AU - Ducomble,Tanja, AU - Eckmanns,Tim, AU - Rodloff,Arne C, PY - 2013/10/02/received PY - 2013/12/02/revised PY - 2013/12/02/accepted PY - 2014/4/1/entrez PY - 2014/4/1/pubmed PY - 2014/11/18/medline KW - Immunosuppression KW - Intestinal colonization KW - KPC KW - Long-term carriage KW - Selection pressure SP - 376 EP - 80 JF - American journal of infection control JO - Am J Infect Control VL - 42 IS - 4 N2 - BACKGROUND: The natural progress of intestinal colonization with Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae (KPC-2-KP) is almost unknown. METHODS: After a large, single-center outbreak of KPC-2-KP, we analyzed carrier prevalence through retrospective and prospective investigation of intestinal KPC-2-KP carriage 1 month, 3 months, 6 months, 1 year, and 2 years after acquisition, defined as the earliest date of KPC-2-KP detection. Rectal swabs or stool samples were collected at baseline and at each visit and submitted for both culture and KPC-specific polymerase chain reaction. Resolution of intestinal KPC-2-KP carriage was defined as a minimum of 3 consecutive negative polymerase chain reaction test results separated by at least 48 hours. RESULTS: In patients available for long-term evaluation 26 out of 84 patients (31%) tested negative for KPC-2-KP after 1 month, 14 out of 34 (41%) after 3 months, 17 out of 26 (65%) after 6 months, 14 out of 19 (74%) after 1 year, and 5 out of 6 (83%) after 2 years. Decolonization of KPC-2-KP was hampered in patients with prolonged or repeated hospitalization (P = .044-.140, depending on the time interval). Two patients retested positive for KPC-2-KP after they had previously shown 3 consecutive negative tests. The longest positive KPC-2-KP carrier status so far was observed after nearly 40 months (1,191 days). CONCLUSIONS: The majority of patients experienced spontaneous decolonization within 6 months after acquisition, mainly after discharge from the hospital. However, long-term carriage of >3 years is possible. Appropriate infection control measures must be taken when these patients are readmitted to health care facilities. A series of at least 4 consecutive negative rectal swabs or stool samples separated by sufficient time intervals appears necessary before the declaration of successful KPC-2-KP decolonization is made. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/24679563/Long_term_carriage_of_Klebsiella_pneumoniae_carbapenemase_2_producing_K_pneumoniae_after_a_large_single_center_outbreak_in_Germany_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(13)01420-X DB - PRIME DP - Unbound Medicine ER -