Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics

Autor: Peera Hemarajata, Venkatara Raman Muthusamy, Romney M. Humphries, Zachary Rubin, Dana Russell, Daniel Z. Uslan, Alisa M Trout, Quen J. Cheng, Shuan Yang, Teresa Zaroda, Stephen Kim, Grace M. Aldrovandi
Rok vydání: 2017
Předmět:
Adult
Male
0301 basic medicine
Microbiology (medical)
medicine.medical_specialty
Adolescent
Klebsiella pneumoniae
Duodenoscopes
030106 microbiology
India
Disease Outbreaks
Young Adult
03 medical and health sciences
0302 clinical medicine
Internal medicine
Humans
Medicine
Pathology
Molecular
Risk factor
Screening cultures
Aged
Aged
80 and over
Cholangiopancreatography
Endoscopic Retrograde
Cross Infection
Endoscopic retrograde cholangiopancreatography
biology
medicine.diagnostic_test
business.industry
Outbreak
Middle Aged
biology.organism_classification
Molecular diagnostics
Klebsiella Infections
Disinfection
Carbapenem-Resistant Enterobacteriaceae
Infectious Diseases
Carbapenems
Case-Control Studies
Equipment Contamination
Female
030211 gastroenterology & hepatology
business
Asymptomatic carrier
Zdroj: Clinical Infectious Diseases. 65:1159-1166
ISSN: 1537-6591
1058-4838
DOI: 10.1093/cid/cix527
Popis: Background Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the blaOXA-232 gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods An outbreak investigation was performed when 9 patients with blaOXA-232 carbapenem-resistant K. pneumoniae infections were identified at a tertiary care hospital. The investigation included 2 case-control studies, review of duodenoscope reprocessing procedures, and culture of devices. Carbapenem-resistant Enterobacteriacieae (CRE) isolates were evaluated with polymerase chain reaction analysis for carbapenemase genes, and isolates with the blaOXA-232 gene were subjected to whole-genome sequencing and chromosome single-nucleotide polymorphism analysis. On recognition of ERCP as a key risk factor for infection, targeted patient notification and CRE screening cultures were performed. Results Molecular testing ultimately identified 17 patients with blaOxa-232 carbapenem-resistant K. pneumoniae isolates, including 9 with infections, 7 asymptomatic carriers who had undergone ERCP, and 1 additional patient who had been hospitalized in India and was probably the initial carrier. Two case-control studies established a point-source outbreak associated with 2 specific duodenoscopes. A field investigation of the use, reprocessing, and storage of deuodenoscopes did not identify deviations from US Food and Drug Administration or manufacturer recommendations for reprocessing. Conclusions This outbreak demonstrated the previously underappreciated potential for duodenoscopes to transmit disease, even after undergoing high-level disinfection according to manufacturers' guidelines.
Databáze: OpenAIRE
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