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Bla-OXA48 gene microorganisms outbreak, in a tertiary Children's Hospital, Over 3 years (2012-2014): Case Report.
Medicine (Baltimore). 2017 Oct; 96(40):e7665.M

Abstract

RATIONALE

Carbapenem-resistant Enterobacteriaceae are an emerging problem in children. Nosocomial spread remains the principal risk factor for acquisition of these microorganisms.

PATIENTS CONCERNS

We describe an outbreak of Klebsiella pneumoniae OXA48 (KOXA48) in a tertiary children's hospital during the years 2012 to 2014, as well as the preventive measures put in place in colonized and infected cases.

DIAGNOSES

We studied, "in vitro," the KOXA48 susceptibility to antiseptics and surface disinfectants. Moreover, an epidemiological surveillance of infection or colonization by these microorganisms, with molecular typing of the KOXA48, was performed, and carbapenemase genes were confirmed by polymerase chain reaction (PCR).

INTERVENTIONS

The bundles recommended (early detection, cohorting of children and health care workers [HCW], contact precautions, etc.) to control the KOXA48 outbreak were taken from those described in the centers for disease control (CDC) 2012 guide, and adapted according to our experience in controlling other outbreaks.

OUTCOMES

All the KOXA48 microorganisms isolated from children belonged to the same strain (ST11) and were susceptible to alcohol solutions but not the surface disinfectant previously employed in our hospital (tensoactive). We reinforced the surface disinfection using a double application (tensoactive + alcohol). The outbreak of KOXA48 begun in 2012 (16 cases in neonatal intensive care unit [NICU] and 1 in pediatric intensive care unit [PICU]) ended before the end of the same year and was not transmitted to new patients in 2013 to 2014, despite readmission of some colonized cases, in intensive care units (ICUs) and other units, of our children hospital.

LESSONS

Infected children are the tip of the iceberg (3/17) of KOXA48 prevalence making it necessary to identify the cases colonized by these bacteria. At the beginning of the outbreak, the susceptibility of the epidemic strain to antiseptics and surface disinfectants should be studied. Moreover, the measures taken (cohorts, contact precautions, etc.) must be thorough in both colonized and infected cases, immediately, after microbiological diagnosis.

Authors+Show Affiliations

aDepartamento de Medicina Preventiva y Salud Publica y Microbiologia Universidad Autónoma de Madrid bServicio de Microbiología Hospital Universitario La Paz cServicio de Medicina Preventiva dNeonatologia, Hospital Universitario La Paz, Madrid, Spain.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28984751

Citation

Herruzo, Rafael, et al. "Bla-OXA48 Gene Microorganisms Outbreak, in a Tertiary Children's Hospital, Over 3 Years (2012-2014): Case Report." Medicine, vol. 96, no. 40, 2017, pp. e7665.
Herruzo R, Ruiz G, Perez-Blanco V, et al. Bla-OXA48 gene microorganisms outbreak, in a tertiary Children's Hospital, Over 3 years (2012-2014): Case Report. Medicine (Baltimore). 2017;96(40):e7665.
Herruzo, R., Ruiz, G., Perez-Blanco, V., Gallego, S., Mora, E., Vizcaino, M. J., & Omeñaca, F. (2017). Bla-OXA48 gene microorganisms outbreak, in a tertiary Children's Hospital, Over 3 years (2012-2014): Case Report. Medicine, 96(40), e7665. https://doi.org/10.1097/MD.0000000000007665
Herruzo R, et al. Bla-OXA48 Gene Microorganisms Outbreak, in a Tertiary Children's Hospital, Over 3 Years (2012-2014): Case Report. Medicine (Baltimore). 2017;96(40):e7665. PubMed PMID: 28984751.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bla-OXA48 gene microorganisms outbreak, in a tertiary Children's Hospital, Over 3 years (2012-2014): Case Report. AU - Herruzo,Rafael, AU - Ruiz,Guillermo, AU - Perez-Blanco,Veronica, AU - Gallego,Sara, AU - Mora,Eduardo, AU - Vizcaino,Maria Jose, AU - Omeñaca,Felix, PY - 2017/10/7/entrez PY - 2017/10/7/pubmed PY - 2017/10/13/medline SP - e7665 EP - e7665 JF - Medicine JO - Medicine (Baltimore) VL - 96 IS - 40 N2 - RATIONALE: Carbapenem-resistant Enterobacteriaceae are an emerging problem in children. Nosocomial spread remains the principal risk factor for acquisition of these microorganisms. PATIENTS CONCERNS: We describe an outbreak of Klebsiella pneumoniae OXA48 (KOXA48) in a tertiary children's hospital during the years 2012 to 2014, as well as the preventive measures put in place in colonized and infected cases. DIAGNOSES: We studied, "in vitro," the KOXA48 susceptibility to antiseptics and surface disinfectants. Moreover, an epidemiological surveillance of infection or colonization by these microorganisms, with molecular typing of the KOXA48, was performed, and carbapenemase genes were confirmed by polymerase chain reaction (PCR). INTERVENTIONS: The bundles recommended (early detection, cohorting of children and health care workers [HCW], contact precautions, etc.) to control the KOXA48 outbreak were taken from those described in the centers for disease control (CDC) 2012 guide, and adapted according to our experience in controlling other outbreaks. OUTCOMES: All the KOXA48 microorganisms isolated from children belonged to the same strain (ST11) and were susceptible to alcohol solutions but not the surface disinfectant previously employed in our hospital (tensoactive). We reinforced the surface disinfection using a double application (tensoactive + alcohol). The outbreak of KOXA48 begun in 2012 (16 cases in neonatal intensive care unit [NICU] and 1 in pediatric intensive care unit [PICU]) ended before the end of the same year and was not transmitted to new patients in 2013 to 2014, despite readmission of some colonized cases, in intensive care units (ICUs) and other units, of our children hospital. LESSONS: Infected children are the tip of the iceberg (3/17) of KOXA48 prevalence making it necessary to identify the cases colonized by these bacteria. At the beginning of the outbreak, the susceptibility of the epidemic strain to antiseptics and surface disinfectants should be studied. Moreover, the measures taken (cohorts, contact precautions, etc.) must be thorough in both colonized and infected cases, immediately, after microbiological diagnosis. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/28984751/Bla_OXA48_gene_microorganisms_outbreak_in_a_tertiary_Children's_Hospital_Over_3_years__2012_2014_:_Case_Report_ L2 - http://dx.doi.org/10.1097/MD.0000000000007665 DB - PRIME DP - Unbound Medicine ER -