We describe an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) ST258 that occurred in two institutions (a hospital and a nursing home) in the Netherlands between July and December 2013. In total, six patients were found to be positive for KPC-KP. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and tigecycline. In all settings, extensive environmental contamination was found. Whole genome sequencing revealed the presence of bla KPC-2 and bla SHV-12 genes, as well as the close relatedness of patient and environmental isolates. In the hospital setting, one transmission was detected, despite contact precautions. After upgrading to strict isolation, no further spread was found. After the transfer of the index patient to a nursing home in the same region, four further transmissions occurred. The outbreak in the nursing home was controlled by transferring all KPC-KP-positive residents to a separate location outside the nursing home, where a dedicated nursing team cared for patients. This outbreak illustrates that the spread of pan-resistant Enterobacteriaceae can be controlled, but may be difficult, particularly in long-term care facilities. It, therefore, poses a major threat to patient safety. Clear guidelines to control reservoirs in and outside the hospitals are urgently needed.

publicatie in  2015 Jun 12

authors:Weterings V1, Zhou K2, Rossen JW2, van Stenis D3, Kluytmans J45, Veenemans J4.

  • 1Laboratory for Microbiology and Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands. vweterings@amphia.nl.
  • 2Molecular Unit, Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
  • 3De Riethorst Stromenland, Geertruidenberg, The Netherlands.
  • 4Laboratory for Microbiology and Infection Control, Amphia Hospital, P.O. Box 90158, 4800 RK, Breda, The Netherlands.
  • 5Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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