scholarly journals Duodenoscope-Associated Outbreak of a Carbapenem Resistant Enterobacteriaceae

2020 ◽  
Vol 41 (S1) ◽  
pp. s197-s197
Author(s):  
Sung Ran Kim ◽  
Joon Young Song ◽  
Min Hee Cho ◽  
Ji Yeon Song
Keyword(s):  
Gel Electrophoresis ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Analysis ◽  
Endoscopic Retrograde ◽  
Carbapenem Resistant ◽  
Case Control Analysis ◽  
Record Review ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Cleaning Protocol

Background: We describe and evaluate our outbreak of carbapenem-resistant K. pneumoniae transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: An outbreak investigation was performed when Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) were identified from bile specimens of 4 patients. The investigation included medical record review, practice audits, and surveillance cultures of duodenoscopes and environmental sites. If available, clinical specimens were obtained from patients who had undergone ERCP in the previous 3 months. Carbapenem-resistant Enterobacteriaceae (CRE) screening cultures were performed to identify additional patients until no CRE cases were detected during 2 consecutive weeks. Pulsed-field gel electrophoresis (PFGE) of KPC-KP isolates was implemented. Results: In total, 12 cases were identified with exposure to duodenoscope from February 2019 through April 2019, including 6 cases with infections and 6 asymptomatic carriers. Case-control analysis showed that 2 specific duodenoscopes would be associated with the KPC-KP outbreak. Duodenoscope reprocessing procedures did not deviate from manufacturer recommendations for reprocessing. After ethylene oxide (EO) gas sterilization, the outbreak was terminated. Conclusions: Meticulous cleaning protocol and enhanced surveillance are necessary to prevent outbreaks of CRE. Notably, enhanced cleaning measures, such as sterilization for duodenoscopes, would be required after procedures with KPC-KP carriers.Funding: NoneDisclosures: None

scholarly journals Outbreak of Staphylococcus schleiferiWound Infections: Strain Characterization by Randomly Amplified Polymorphic DNA Analysis, PCR Ribotyping, Conventional Ribotyping, and Pulsed-Field Gel Electrophoresis

1998 ◽  
Vol 36 (8) ◽  
pp. 2214-2219 ◽  
Author(s):  
Jan Kluytmans ◽  
Hans Berg ◽  
Paul Steegh ◽  
François Vandenesch ◽  
Jerome Etienne ◽  
...  
Keyword(s):  
Gel Electrophoresis ◽  
Dna Analysis ◽  
Surgical Site Infections ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Analysis ◽  
Coagulase Negative Staphylococci ◽  
Pulsed Field ◽  
Strain Characterization ◽  
Causative Microorganism

Within a 1-year period, six surgical-site infections (SSI) caused by Staphylococcus schleiferi were observed in the department of cardiac surgery of Ignatius Hospital, Breda, The Netherlands. Since outbreaks caused by this species of coagulase-negative staphylococci have not been described before, an extensive environmental survey and a case control study were performed in combination with molecular typing of the causative microorganism in order to identify potential sources of infection. Variability, as detected by four different genotyping methods (random amplification of polymorphic DNA [RAPD], conventional and PCR-mediated ribotyping, and pulsed-field gel electrophoresis [PFGE] of DNA macro restriction fragments), appeared to be limited both among the clinical isolates and among several control strains obtained from various unrelated sources. Among unrelated strains, RAPD and PCR-mediated ribotyping identified two types only, whereas seven different types were identified in a relatively concordant manner by conventional ribotyping and PFGE. The latter two procedures proved to be the most useful tools for tracking the epidemiology of S. schleiferi. Four of the outbreak-related strains were identical by both methods, and two isolates showed limited differences. In the search for a potential source of S. schleiferi infection, two slightly different PFGE types were encountered on several occasions in the nose of a single surgeon. These strains were, however, clearly different from the outbreak type. In contrast, S. schleiferi cultures remained negative for two persons identified on the basis of case control analysis. It was demonstrated that SSI caused by S. schleiferi had a clinical impact for patients comparable to that of a wound infection caused by Staphylococcus aureus. This report describes the first well-documented outbreak of S. schleiferi infection. A source of the outbreak was not detected.

The Predominance of Strain Replacement Among Enterobacteriaceae Pairs With Emerging Carbapenem Resistance During Hospitalization

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S215-S219
Author(s):  
Baixing Ding ◽  
Zhen Shen ◽  
Xiaohua Qin ◽  
Yang Yang ◽  
Xiaogang Xu ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Gel Electrophoresis ◽  
Carbapenem Resistance ◽  
Tertiary Hospital ◽  
Pulsed Field Gel Electrophoresis ◽  
Pulsed Field ◽  
Carbapenem Resistant ◽  
Sequence Types ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Isolates of Enterobacteriaceae collected from the same patient can lose carbapenem susceptibility during antimicrobial therapy, but little attention has been given to how this conversion takes place. In the current study, we retrospectively analyzed microbiological and clinical data from patients with enterobacterial infections at a tertiary hospital in Shanghai, China. After screening 4795 patients and 7120 Enterobacteriaceae isolates over the 3-year study period, we found the change from carbapenem susceptible to carbapenem resistant in 41 pairs of isolates, of which 35 pairs (85.4%) were K. pneumoniae and 25 (61.0%) were from the same anatomic sites. Thirty-six isolate pairs showed different pulsed-field gel electrophoresis patterns between the carbapenem-susceptible and the corresponding resistant strain, and 5 pairs displayed identical pulsed-field gel electrophoresis patterns. Thirty-three (91.7%) of the 36 pairs of Enterobacteriaceae isolates were carbapenem-resistant K. pneumoniae with blaKPC-2, and 28 pairs (90.3%) of K. pneumoniae isolates had different sequence types (STs), with ST11 the most common ST found in carbapenem-resistant K. pneumoniae isolates. Forty of the 41 patients had received antimicrobial therapy such as carbapenems, cephalosporins, and fluoroquinolones, before the isolation of carbapenem-resistant Enterobacteriaceae. These results demonstrated that strain replacement is the main cause of emerging carbapenem resistance in Enterobacteriaceae during hospitalization. The loss of carbapenem susceptibility was not mainly due to in vivo development of carbapenem resistance.

Multidrug-ResistantPseudomonas aeruginosaCholangitis After Endoscopic Retrograde Cholangiopancreatography: Failure of Routine Endoscope Cultures to Prevent an Outbreak

2004 ◽  
Vol 25 (10) ◽  
pp. 856-859 ◽  
Author(s):  
Thomas G. Fraser ◽  
Sandra Reiner ◽  
Michael Malczynski ◽  
Paul R. Yarnold ◽  
John Warren ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Case Control ◽  
Control Analysis ◽  
Surveillance Culture ◽  
Endoscopic Retrograde ◽  
Infectious Morbidity ◽  
Surveillance Cultures ◽  
Case Control Analysis

AbstractBackground:Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistantPseudomonas aeruginosaafter endoscopic retrograde cholangiopancreatography (ERCP).Objective:To describe an outbreak of multidrug-resistantP. aeruginosasepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes.Design:A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope.Setting:A tertiary-care academic medical center.Results:The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive forPseudomonas(P= .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier.Conclusions:Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

scholarly journals Detection of the novel IMP-38 among carbapenemase-producing Enterobacteriaceae in a university hospital, China

2014 ◽  
Vol 8 (08) ◽  
pp. 1044-1048 ◽  
Author(s):  
Zijuan Jian ◽  
Yanming Li ◽  
Wenen Liu ◽  
Hongling Li ◽  
Yunli Zhang ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Molecular Epidemiology ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
University Hospital ◽  
The Novel ◽  
Pulsed Field ◽  
Carbapenem Resistant ◽  
Neonatal Ward ◽  
Carbapenem Resistant Enterobacteriaceae

Introduction: This study set out to investigate the molecular epidemiology of carbapenemase-producing Enterobacteriaceae isolates collected from Xiang Ya Hospital, Hunan, China. Methodology: The carbapenemase genes from Enterobacteriaceae isolates were determined by PCR and sequencing. Relatedness of Klebsiella pneumoniae isolates was evaluated by pulsed-field gel electrophoresis. Results: Twenty-four out of 738 non-repetitive Enterobacteriaceae isolates harbored carbapenemase genes including IMP-38, a novel IMP-type metallo-enzyme. Nine IMP-38-producing isolates were shown to originate from the same clone and caused a small outbreak in the neonatal ward. Conclusions: IMP-38, a novel IMP-type metallo-enzyme, was one of the predominant types of carbapenemase in the clinical carbapenem-resistant Enterobacteriaceae isolates in our hospital.

scholarly journals Source Tracking of Carbapenem-Resistant Enterobacteriaceae Outbreaks in Neonatal Patients Revealed Rivers Contaminated with NDM Genes

2021 ◽  
Author(s):  
Jianshjeng Wang ◽  
Changfu Yin ◽  
Yuanpeng Lv ◽  
Weiwei Yang ◽  
Peng Zhao
Keyword(s):  
Gastric Lavage ◽  
Epidemiological Data ◽  
Control Measures ◽  
Source Tracking ◽  
Control Analysis ◽  
Age Group ◽  
Carbapenem Resistant ◽  
Underlying Mechanisms ◽  
Case Control Analysis ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) prevalence in neonatal patients continues to rise in china. However, very few epidemiological data are available to uncover the underlying mechanisms for the increase. This study aimed to elucidate their transmission modes and explore potential sources. Methods The genotypic features of CRE isolates were analyzed by PCR and sequencing. The elucidation of transmission and sources involved in electronic medical record review, environmental cultures, screening cultures, and prospective case-control analysis. Results A total of 450 CRE isolates recovered from 369 infant patients were genotypically characterised. Carbapenemase genes NDM-1, KPC-2 and IMP-4 accounted for 86.22% (n = 388), 8.89% (n = 40) and 4.44% (n = 20), respectively. After implementation of intensified control measures, CRE rectal prevalence rates in both the 0–3 days and the 4–28 days age group were decreased from 15.53% (100/644) and 27.37% (52/190) to 11.78% (51/433) and 19.59% (19/97) (P = 0.082 and P = 0.148), respectively. Multivariate analysis showed that gastric lavage (odds ratio [OR]) 3.09, 95% confidence interval [CI] 1.49–6.39) and enema (OR 2.84, 95% CI 1.65–4.91) were independent risk factors for rectal colonisation in the 0–3 days age group, whereas Cephalosporins (OR 2.12, 95% CI 1.14–3.94), gastric lavage (OR 3.44, 95% CI 1.44–8.22) and residence in rural area (OR 2.22, 95% CI 1.19–4.13) were independently associated with rectal colonization in the 4–28 days age group. The strict management of aseptic procedures eventually halted the silent spread. The transmission tracking of neonatal NDM-1 strains outbreaks revealed rivers contaminated with NDM genes. Conclusions Continued vigilance for importations should be maintained to reduce CRE threat. Community awareness raising campaigns are urgently needed to reduce CRE threat.

scholarly journals Source Tracking of Carbapenem-Resistant Enterobacteriaceae Outbreaks in Neonatal Patients Revealed Rivers Contaminated with NDM Genes

2021 ◽  
Author(s):  
Jianshjeng Wang ◽  
Changfu Yin ◽  
Yuanpeng Lv ◽  
Weiwei Yang ◽  
Peng Zhao
Keyword(s):  
Gastric Lavage ◽  
Epidemiological Data ◽  
Control Measures ◽  
Source Tracking ◽  
Control Analysis ◽  
Age Group ◽  
Carbapenem Resistant ◽  
Underlying Mechanisms ◽  
Case Control Analysis ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background: Carbapenem-resistant Enterobacteriaceae (CRE) prevalence in neonatal patients continues to rise in china. However, very few epidemiological data are available to uncover the underlying mechanisms for the increase. This study aimed to elucidate their transmission modes and explore potential sources. Methods: The genotypic features of CRE isolates were analyzed by PCR and sequencing. The elucidation of transmission and sources involved in electronic medical record review, environmental cultures, screening cultures, and prospective case-control analysis. The transferability of carbapenem-resistant genes was performed by Conjugation experiments.Results: A total of 450 CRE isolates recovered from 369 infant patients were genotypically characterised. Carbapenemase genes NDM-1, KPC-2 and IMP-4 accounted for 86.22% (n = 388), 8.89% (n = 40) and 4.44% (n = 20), respectively. After implementation of intensified control measures, CRE rectal prevalence rates in both the 0-3 days and the 4-28 days age group were decreased from 15.53% (100/644) and 27.37% (52/190) to 11.78% (51/433) and 19.59% (19/97) (P = 0.082 and P = 0.148), respectively. Multivariate analysis showed that gastric lavage (odds ratio [OR]) 3.09, 95% confidence interval [CI] 1.49–6.39) and enema (OR 2.84, 95% CI 1.65–4.91) were independent risk factors for rectal colonisation in the 0-3 days age group, whereas Cephalosporins (OR 2.12, 95% CI 1.14–3.94), gastric lavage (OR 3.44, 95% CI 1.44–8.22) and residence in rural area (OR 2.22, 95% CI 1.19–4.13) were independently associated with rectal colonization in the 4-28 days age group. The transmission tracking of neonatal NDM-1 strains outbreaks revealed rivers contaminated with NDM genes. Most isolates with NDM genes could be successfully transferred.Conclusion: Continued vigilance for importations should be maintained to reduce CRE threat.

The epidemiological impact and significance of carbapenem resistance in Pseudomonas aeruginosa bloodstream infections: a matched case–case-control analysis

2018 ◽  
Vol 39 (10) ◽  
pp. 1262-1265 ◽  
Author(s):  
Tzach Aviv ◽  
Tsillia Lazarovitch ◽  
David Katz ◽  
Ronit Zaidenstein ◽  
Mor Dadon ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Carbapenem Resistance ◽  
Bloodstream Infections ◽  
Case Control ◽  
Control Analysis ◽  
Carbapenem Resistant ◽  
Appropriate Therapy ◽  
Matched Case ◽  
Epidemiological Impact ◽  
Case Control Analysis

AbstractA case–case-control investigation (N = 255 patients) explored the epidemiology of carbapenem-resistant Pseudomonas aeruginosa (CRPA). Recent exposure to carbapenems and a rapidly fatal condition should prompt practitioners to shorten delays in initiating appropriate therapy, which can adversely impact CRPA outcomes, as opposed to the isolated impact of the carbapenem resistance determinant.

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