Bronchoscope-associated clusters of multidrug-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae
| Autor: | Amy Metzger, A. William Pasculle, Marissa P Pacey, Alison Galdys, Ashley M Ayres, Lee H. Harrison, Edgar Delgado, Carlene A. Muto, Jane W. Marsh |
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| Rok vydání: | 2018 |
| Předmět: |
Microbiology (medical)
Epidemiology Klebsiella pneumoniae medicine.drug_class Antibiotics Microbial Sensitivity Tests Drug resistance 030501 epidemiology medicine.disease_cause Disease Outbreaks Microbiology 03 medical and health sciences Drug Resistance Multiple Bacterial medicine Pulsed-field gel electrophoresis Humans Pseudomonas Infections Retrospective Studies Whole Genome Sequencing Molecular epidemiology biology Pseudomonas aeruginosa business.industry Pennsylvania biology.organism_classification medicine.disease Anti-Bacterial Agents Klebsiella Infections Multiple drug resistance Intensive Care Units Pneumonia Bronchoscopes Infectious Diseases Equipment Contamination 0305 other medical science business |
| Zdroj: | Infection Control & Hospital Epidemiology. 40:40-46 |
| ISSN: | 1559-6834 0899-823X |
| Popis: | ObjectiveRecovery of multidrug-resistant (MDR) Pseudomonas aeruginosa and Klebsiella pneumoniae from a cluster of patients in the medical intensive care unit (MICU) prompted an epidemiologic investigation for a common exposure.MethodsClinical and microbiologic data from MICU patients were retrospectively reviewed, MICU bronchoscopes underwent culturing and borescopy, and bronchoscope reprocessing procedures were reviewed. Bronchoscope and clinical MDR isolates epidemiologically linked to the cluster underwent molecular typing using pulsed-field gel electrophoresis (PFGE) followed by whole-genome sequencing.ResultsOf the 33 case patients, 23 (70%) were exposed to a common bronchoscope (B1). Both MDR P. aeruginosa and K. pneumonia were recovered from the bronchoscope’s lumen, and borescopy revealed a luminal defect. Molecular testing demonstrated genetic relatedness among case patient and B1 isolates, providing strong evidence for horizontal bacterial transmission. MDR organism (MDRO) recovery in 19 patients was ultimately linked to B1 exposure, and 10 of 19 patients were classified as belonging to an MDRO pseudo-outbreak.ConclusionsSurveillance of bronchoscope-derived clinical culture data was important for early detection of this outbreak, and whole-genome sequencing was important for the confirmation of findings. Visualization of bronchoscope lumens to confirm integrity should be a critical component of device reprocessing. |
| Databáze: | OpenAIRE |
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