Skip to main content

Advertisement

SpringerLink
Log in

An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

We describe an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) ST258 that occurred in two institutions (a hospital and a nursing home) in the Netherlands between July and December 2013. In total, six patients were found to be positive for KPC-KP. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and tigecycline. In all settings, extensive environmental contamination was found. Whole genome sequencing revealed the presence of bla KPC-2 and bla SHV-12 genes, as well as the close relatedness of patient and environmental isolates. In the hospital setting, one transmission was detected, despite contact precautions. After upgrading to strict isolation, no further spread was found. After the transfer of the index patient to a nursing home in the same region, four further transmissions occurred. The outbreak in the nursing home was controlled by transferring all KPC-KP-positive residents to a separate location outside the nursing home, where a dedicated nursing team cared for patients. This outbreak illustrates that the spread of pan-resistant Enterobacteriaceae can be controlled, but may be difficult, particularly in long-term care facilities. It, therefore, poses a major threat to patient safety. Clear guidelines to control reservoirs in and outside the hospitals are urgently needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Glasner C, Albiger B, Buist G, Tambić Andrašević A, Cantón R, Carmeli Y, Friedrich AW, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Nordmann P, Poirel L, Rossolini GM, Seifert H, Vatopoulos A, Walsh T, Woodford N, Donker T, Monnet DL, Grundmann H; the European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) working group (2013) Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. Euro Surveill 18(28). pii: 20525. Available online at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20525

  2. Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y (2008) Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 52:1028–1033

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Mezzatesta ML, Gona F, Caio C, Petrolito V, Sciortino D, Sciacca A, Santangelo C, Stefani S (2011) Outbreak of KPC-3-producing, and colistin-resistant, Klebsiella pneumoniae infections in two Sicilian hospitals. Clin Microbiol Infect 17(9):1444–1447

    Article  CAS  PubMed  Google Scholar 

  4. Bogdanovich T, Adams-Haduch JM, Tian G-B, Nguyen MH, Kwak EJ, Muto CA, Doi Y (2011) Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258. Clin Infect Dis 53(4):373–376

    Article  PubMed Central  PubMed  Google Scholar 

  5. Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez A, Pollini S; Network EuSCAPE-Italy, Grundmann H, Pantosti A, Rossolini GM (2014) Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill 19(42). pii: 20939. Available online at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20939

  6. Steinmann J, Kaase M, Gatermann S, Popp W, Steinmann E, Damman M, Paul A, Saner F, Buer J, Rath PM (2011) Outbreak due to a Klebsiella pneumoniae strain harbouring KPC-2 and VIM-1 in a German university hospital, July 2010 to January 2011. Euro Surveill 16(33). pii: 19944. Available online at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19944

  7. Tofteland S, Naseer U, Lislevand JH, Sundsfjord A, Samuelsen Ø (2013) A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One 8(3):e59015. doi:10.1371/journal.pone.0059015

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Mammina C, Bonura C, Di Bernardo F, Aleo A, Fasciana T, Sodano C, Saporito MA, Verde MS, Tetamo R, Palma DM (2012) Ongoing spread of colistin-resistant Klebsiella pneumoniae in different wards of an acute general hospital, Italy, June to December 2011. Euro Surveill 17(33). pii: 20248. Available online at: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20248

  9. Chen L, Mathema B, Chavda KD, DeLeo FR, Bonomo RA, Kreiswirth BN (2014) Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding. Trends Microbiol 22(12):686–696

    Article  CAS  PubMed  Google Scholar 

  10. Chen L, Mathema B, Pitout JDD, DeLeo FR, Kreiswirth BN (2014) Epidemic Klebsiella pneumoniae ST258 is a hybrid strain. MBio 5(3):e01355-14. doi:10.1128/mBio.01355-14

    Article  PubMed Central  PubMed  Google Scholar 

  11. Deleo FR, Chen L, Porcella SF, Martens CA, Kobayashi SD, Porter AR et al (2014) Molecular dissection of the evolution of carbapenem-resistant multilocus sequence type 258 Klebsiella pneumoniae. Proc Natl Acad Sci U S A 111(13):4988–4993

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. European Centre for Disease Prevention and Control (ECDC) (2014) Surveillance report. Antimicrobial resistance surveillance in Europe, 2013. Available online at: http://ecdc.europa.eu/en/publications/Publications/antimicrobial-resistance-surveillance-europe-2013.pdf. Accessed 23 March 2015

  13. Werkgroep Infectie Preventie (WIP). Maatregelen tegen overdracht van bijzonder resistente micro-organismen (BRMO). Available online at: http://www.wip.nl/free_content/Richtlijnen/BRMO.pdf. Leiden, 2010

  14. Mohammadi T, Reesink HW, Pietersz RNI, Vandenbroucke-Grauls CMJE, Savelkoul PHM (2005) Amplified-fragment length polymorphism analysis of Propionibacterium isolates implicated in contamination of blood products. Br J Haematol 131(3):403–409

    Article  CAS  PubMed  Google Scholar 

  15. Freeman JT, Nimmo J, Gregory E, Tiong A, De Almeida M, McAuliffe GN et al (2014) Predictors of hospital surface contamination with extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae: patient and organism factors. Antimicrob Resist Infect Control 3:5

    Article  PubMed Central  PubMed  Google Scholar 

  16. Cochard H, Aubier B, Quentin R, van der Mee-Marquet N; Réseau des Hygiénistes du Centre (2014) Extended-spectrum β-lactamase-producing Enterobacteriaceae in French nursing homes: an association between high carriage rate among residents, environmental contamination, poor conformity with good hygiene practice, and putative resident-to-resident transmission. Infect Control Hosp Epidemiol 35(4):384–389

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We would like to acknowledge the healthcare workers who contributed to the investigation and the control of this outbreak, and all staff at the Laboratory for Microbiology and Infection Control of Amphia Hospital Breda. Special thanks are due to L. van Boxel (team manager, De Riethorst Stromenland), L. Dekker (communication, De Riethorst Stromenland), A. de Laat (manager, De Riethorst Stromenland), S. Raven (MD Communicable Disease Control at Municipal Health Service West-Brabant), E. Verkade (clinical microbiologist, Amphia Hospital Breda), K. Verwoert (nurse, De Riethorst Stromenland), B. Vos (location manager, De Riethorst Stromenland), and E. Weterings (infection control practitioner, Amphia Hospital Breda).

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Laboratory for Microbiology and Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands

    V. Weterings, J. Kluytmans & J. Veenemans

  2. Molecular Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

    K. Zhou & J. W. Rossen

  3. De Riethorst Stromenland, Geertruidenberg, The Netherlands

    D. van Stenis & E. Thewessen

  4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    J. Kluytmans

Authors
  1. V. Weterings
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. K. Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. W. Rossen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. van Stenis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Thewessen
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Kluytmans
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Veenemans
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to V. Weterings.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Weterings, V., Zhou, K., Rossen, J.W. et al. An outbreak of colistin-resistant Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae in the Netherlands (July to December 2013), with inter-institutional spread. Eur J Clin Microbiol Infect Dis 34, 1647–1655 (2015). https://doi.org/10.1007/s10096-015-2401-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-015-2401-2

Keywords

Search

Navigation