Evidence of transmission of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae through a gastrointestinal endoscope without an elevator channel.

Autor:	Yang AF; Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Sherman A; Communicable Disease Service, New Jersey Department of Health, Trenton, NJ, USA., Nazarian E; Wadsworth Center, New York State Department of Health, Albany, NY, USA., Haas W; Wadsworth Center, New York State Department of Health, Albany, NY, USA., Mehr J; Communicable Disease Service, New Jersey Department of Health, Trenton, NJ, USA., Pedrani M; Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Kirn T; Department of Pathology & Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Brant S; Department of Medicine, Division of Gastroenterology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Boruchoff SE; Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Kaye KS; Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA., Mills JP; Department of Medicine, Division of Allergy, Immunology, and Infectious Diseases, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Jazyk:	angličtina
Zdroj:	Infection control and hospital epidemiology [Infect Control Hosp Epidemiol] 2024 Apr 02, pp. 1-6. Date of Electronic Publication: 2024 Apr 02.
DOI:	10.1017/ice.2024.55
Abstrakt:	Objective: To investigate the source and transmission dynamics of an endoscope-associated New Delhi metallo-β-lactamase-producing Klebsiella pneumonia (NDM-KP) outbreak. Design: Epidemiological and genomic investigation. Setting: Academic acute care hospital in New Jersey. Patients: Five patients with active NDM-KP infection identified on clinical isolates, and four NDM-KP colonized patients identified via rectal swab screening. Results: Over a twelve-month period, nine patients were identified with NDM-KP infection or colonization. Whole-genome sequencing (WGS) revealed that all of the identified cases were related by 25 mutational events or less. Seven of the cases were linked to gastrointestinal endoscopic procedures (four clinical cases and three positive screens among patients exposed to endoscopes suspected of transmission). Two cases demonstrated delayed transmission that occurred five months after the initial outbreak, likely through shared usage of a non-therapeutic gastroscope without an elevator channel. Conclusions: Although all endoscope cultures in our investigation were negative, the epidemiological link to gastrointestinal endoscopes, the high degree of relatedness via WGS, and the identification of asymptomatic NDM-KP colonization among patients exposed to shared endoscopes make the endoscopic mode of transmission most likely. This investigation highlights the probable transmission of NDM-KP via a gastroscope without an elevator channel, observed several months after an initial outbreak. We hypothesize that persistent mechanical defects may have contributed to the delayed device-related transmission of NDM-KP.
Databáze:	MEDLINE
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