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Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing.
J Hosp Infect 2019; 101(2):150-157JH

Abstract

BACKGROUND

Following the alarming outbreak of carbapenem-resistant Klebsiella pneumonia (CRKP) in five intensive care units (ICUs) of a tertiary care hospital in China, a prospective investigation of CRKP colonized/infected patients was conducted.

AIM

To describe the diffusion and transmission of CRKP among epidemiologically linked ICU patients, staff and environment.

METHODS

Enhanced CRKP infected/colonized case monitoring was performed by the real-time nosocomial infection surveillance system (RT-NISS). The immediate surroundings of each CRKP patient bed unit and the staff hands/gloves/gowns were sampled and then evaluated for the presence of CRKP. Antimicrobial susceptibility tests, pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) were used to identify and to characterize these isolates.

FINDINGS

Among 2750 patients monitored, 67 CRKP patients were newly labeled and 11 patients' CRKP isolates were available. A total of 31.34% (21/67) bed units were positive at one or more surrounding surfaces, 7.99% (49/613) environmental samples and 3.57% (4/112) ICU staff samples were CRKP positive. The selected CRKP isolates (N = 64) exhibited intermediate to high resistance levels to the antibiotics tested apart from colistin and tigecycline. RT-NISS data combined with MLST and PFGE revealed nine likely transmission clusters. WGS analysis of these CRKP isolates revealed extensive sharing of multiple antimicrobial resistance genes and plasmid replicons among these isolates. Two carbapenemase genes blaKPC-2 (62/64) and blaOXA-48 (2/64) were identified. These CRKP isolates carried one or more plasmid replicons.

CONCLUSIONS

The contamination of ICU environment and staff's hands, gloves or gowns is frequent with CRKP patients. Our study also supports the hypothesis that an association between environmental contamination and transmission of CRKP bacteria in ICUs.

Authors+Show Affiliations

Department of Nanlou Nosocomial Infection Management, Chinese PLA General Hospital, Beijing, China.Department of Nanlou Clinical Laboratory, Chinese PLA General Hospital, Beijing, China.Department of Nosocomial Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.Department of Nosocomial Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.Department of Nosocomial Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.Department of Nanlou Clinical Laboratory, Chinese PLA General Hospital, Beijing, China.Institute for Disease Control and Prevention of PLA, Beijing, China.State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.Department of Nosocomial Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China. Electronic address: 1583279351@qq.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30529506

Citation

Yan, Zhongqiang, et al. "Prospective Investigation of Carbapenem-resistant Klebsiella Pneumonia Transmission Among the Staff, Environment and Patients in Five Major Intensive Care Units, Beijing." The Journal of Hospital Infection, vol. 101, no. 2, 2019, pp. 150-157.
Yan Z, Zhou Y, Du M, et al. Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing. J Hosp Infect. 2019;101(2):150-157.
Yan, Z., Zhou, Y., Du, M., Bai, Y., Liu, B., Gong, M., ... Liu, Y. (2019). Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing. The Journal of Hospital Infection, 101(2), pp. 150-157. doi:10.1016/j.jhin.2018.11.019.
Yan Z, et al. Prospective Investigation of Carbapenem-resistant Klebsiella Pneumonia Transmission Among the Staff, Environment and Patients in Five Major Intensive Care Units, Beijing. J Hosp Infect. 2019;101(2):150-157. PubMed PMID: 30529506.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing. AU - Yan,Zhongqiang, AU - Zhou,Yu, AU - Du,Mingmei, AU - Bai,Yanling, AU - Liu,Bowei, AU - Gong,Meiliang, AU - Song,Hongbin, AU - Tong,Yigang, AU - Liu,Yunxi, Y1 - 2018/12/06/ PY - 2018/10/29/received PY - 2018/11/29/accepted PY - 2018/12/12/pubmed PY - 2019/3/5/medline PY - 2018/12/12/entrez KW - Carbapenem-resistant Klebsiella pneumonia KW - Environmental contamination KW - Intensive care unit KW - Staff KW - Transmission KW - Whole-genome sequencing SP - 150 EP - 157 JF - The Journal of hospital infection JO - J. Hosp. Infect. VL - 101 IS - 2 N2 - BACKGROUND: Following the alarming outbreak of carbapenem-resistant Klebsiella pneumonia (CRKP) in five intensive care units (ICUs) of a tertiary care hospital in China, a prospective investigation of CRKP colonized/infected patients was conducted. AIM: To describe the diffusion and transmission of CRKP among epidemiologically linked ICU patients, staff and environment. METHODS: Enhanced CRKP infected/colonized case monitoring was performed by the real-time nosocomial infection surveillance system (RT-NISS). The immediate surroundings of each CRKP patient bed unit and the staff hands/gloves/gowns were sampled and then evaluated for the presence of CRKP. Antimicrobial susceptibility tests, pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) were used to identify and to characterize these isolates. FINDINGS: Among 2750 patients monitored, 67 CRKP patients were newly labeled and 11 patients' CRKP isolates were available. A total of 31.34% (21/67) bed units were positive at one or more surrounding surfaces, 7.99% (49/613) environmental samples and 3.57% (4/112) ICU staff samples were CRKP positive. The selected CRKP isolates (N = 64) exhibited intermediate to high resistance levels to the antibiotics tested apart from colistin and tigecycline. RT-NISS data combined with MLST and PFGE revealed nine likely transmission clusters. WGS analysis of these CRKP isolates revealed extensive sharing of multiple antimicrobial resistance genes and plasmid replicons among these isolates. Two carbapenemase genes blaKPC-2 (62/64) and blaOXA-48 (2/64) were identified. These CRKP isolates carried one or more plasmid replicons. CONCLUSIONS: The contamination of ICU environment and staff's hands, gloves or gowns is frequent with CRKP patients. Our study also supports the hypothesis that an association between environmental contamination and transmission of CRKP bacteria in ICUs. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/30529506/Prospective_investigation_of_carbapenem_resistant_Klebsiella_pneumonia_transmission_among_the_staff_environment_and_patients_in_five_major_intensive_care_units_Beijing_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(18)30674-1 DB - PRIME DP - Unbound Medicine ER -