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Findings from an outbreak of carbapenem-resistant Klebsiella pneumoniae emphasize the role of antibiotic treatment for cross transmission

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Abstract

Purpose

In January 2015, we noticed by rectal swab analyses that seven of 23 patients at an early rehabilitation ward had been colonized with carbapenem-resistant Klebsiella pneumoniae (CKP). Here, we describe risk factors for CKP acquisition.

Methods

In the present study, the outbreak is described and risk factors for CKP acquisition are examined, e.g., antibiotic treatment. Microbiological analyses including corresponding results were examined to study when colonization with CKP occurred and whether patients had suffered from diarrhea. To examine whether spread of bacteria was clonal, multi-locus sequence typing as well as Xbal macrorestriction and pulsed-field gel electrophoresis was performed. The presence of carbapenmase was examined by PCR analysis. Through univariate analysis of risk factors in the small study sample, the role of antibiotic consumption, isolation procedures, patient’s age, gender, and Barthel index on colonization was elucidated.

Results

Clonal spread of the novel sequence type (ST)2255 was identified. Additionally, one patient was colonized with Escherichia coli and Serratia marcescens, both resistant to carbapenems, while a further patient carried another carbapenem-resistant E. coli strain. In all isolates, carbapenemase gene bla OXA-48 was found to be located on a conjugative plasmid (60 kb), suggesting in vivo transmission from CKP to E. coli and S. marcescens. Univariate tests indicated that antibiotic treatment was the only risk factor showing a significant association with being colonized by CKP. In addition, the likelihood of diarrhea appeared to be higher in this group. Antibiotic treatment was associated with CKP colonization, whereas patients´ age, gender, Barthel index at admission, and residence with a CKP-colonized roommate were not. Diarrhea also seemed to support to distribution of CKP.

Conclusions

In this small outbreak, antibiotic treatment seemed to be the predominant risk factor for monoclonal transmission of bla OXA-48 positive CKP.

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Acknowledgements

We thank Sibylle Müller-Bertling, Kirstin Ganske and Christine Schmidt for excellent technical assistance and Carolyn Dumont Wack for language editing.

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Authors and Affiliations

  1. Department of Infectious Diseases and Infection Control, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany

    Stefan Borgmann, Beate Rieß & Rabea Siegmund

  2. Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany

    Yvonne Pfeifer & Laura Becker

  3. Clinical Institute of Hygiene and Microbiology, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria

    Ulrich Sagel

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  1. Stefan Borgmann
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  2. Yvonne Pfeifer
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Corresponding author

Correspondence to Stefan Borgmann.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

The study has not been funded.

Ethical standards

The study does not contain clinical studies or patient data allowing conclusion to patients’ identity or individual clinical course. According to the ethics committee of the Bavarian medical association (Bayerische Landesärztekammer, http://www.blaek.de), having jurisdiction over medical matters in our state (Federal State Bavaria), ethics approval is not necessary.

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Borgmann, S., Pfeifer, Y., Becker, L. et al. Findings from an outbreak of carbapenem-resistant Klebsiella pneumoniae emphasize the role of antibiotic treatment for cross transmission. Infection 46, 103–112 (2018). https://doi.org/10.1007/s15010-017-1103-3

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  • DOI: https://doi.org/10.1007/s15010-017-1103-3

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