[Monoclonal spread of multi-drug resistant CTX-M-15-producing Klebsiella pneumoniae. Impact of measures to control the outbreak].

Autor:	Asencio Egea MA; María Ángeles Asencio Egea, Laboratorio de Microbiología. Hospital General La Mancha Centro, Avenida de la Constitución 3. 13600 Alcázar de San Juan, Cuidad Real, Spain. marian_asencio@yahoo.es., Huertas Vaquero M, Muñoz-Cuevas C, Gaitán Pitera J, Herráez Carrera O, Alcázar Carmona P, Patiño Ortega HD, Franco Huerta M, Román Ortiz C, Conde García MC, Carranza González R, Barberá JR, Bautista Sánchez V
Jazyk:	Spanish; Castilian
Zdroj:	Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia [Rev Esp Quimioter] 2018 Jun; Vol. 31 (3), pp. 237-246. Date of Electronic Publication: 2018 May 18.
Abstrakt:	Objective: To describe an outbreak of multi-drug resistant extended-spectrum β-lactamases-producing Klebsiella pneumoniae (MDR-ESBL-KPN) and the impact of measures for its control. Methods: We reviewed the patients´ clinical records with MDR-ESBL-KPN isolation during 2013-2016 with resistance to fluoroquinolones, aminoglycosides, fosfomycin, and nitrofurantoin; susceptible to imipenem, meropenem, colistin, and tigecycline and variable to ertapenem and cotrimoxazole (Vitek-2). The genetic relationship between 35 isolates was established by PFGE and MLST. Control measures were put in place in January 2016. Results: We detected 269 patients colonized and/or infected by KPN-ESBL-MDR with a common resistance phenotype; the strains studied carried the blaCTX-M-15 gene and formed a single cluster belonging to ST11. The outbreak was detected at the end of 2015, although it began in 2013 in an elderly center. The acquisition source of the strains was: 6% community-acquired, 37% hospital-acquired (76% in internal medicine) and 57% related to long health care facilities (78% of hospitalizations in the last year). Ninety-four percent of patients had at least one underlying disease, 90% received antibiotics previously and 49% had some invasive devices. After the introduction of control measures, the incidence of cases in the quarter was reduced from 29 to 15. Conclusions: We detected a monoclonal outbreak of MDR-CTX-M-15-KPN in 2015, with predominance of health-care associated cases. The success in the rapid spread of the outbreak was due to the delay in its detection and to the fact that most of the patients had previously received antibiotics. The control measures reduced the number of isolates by 50%. (©The Author 2018. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).)
Databáze:	MEDLINE
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