Carbapenem-resistant Gram-negativesSunday, April 11, 2010, 13:30 - 14:30
First outbreak of carbapenemase-producing Klebsiella pneumoniae in a tuberculosis care facility in the NetherlandsN. Meessen*, J. Wiersinga, K. van der Zwaluw, R. van Altena (Groningen, Bilthoven, NL)
Background: Carbapenems are drugs of choice for serious infections caused by ESBL producers. Klebsiella pneumoniae carbapenemase (KPC) is a beta-lactamase which confers resistance to all beta-lactam antibiotics, including carbapenems. Clonal expansion of KPC producing K. pneumoniae (KPC-Kp) is emerging in Europe. KPC producing strains are particularly alarming due to the multidrug resistance which is carried on plasmids.
Methods: Identification and susceptibility testing of isolates were performed with Vitek2 and Etest. Carbapenemase and other beta-lactamase genes were identified by PCR. PFGE was used for epidemiological comparisons. Medical records of patients that harboured KPC producers were retrospectively reviewed to ascertain factors that may have influenced the acquisition and persistence of the organism.
Results: After admission to the university hospital, a multidrug-resistant Kp was isolated from a wound of a leukaemic patient. The patient was isolated and no intrahospital transmission was observed. However, screening of all patients in the 20-bed extramural TB-care facility where the patient initially stayed, revealed another 6 patients with carbapenem-resistant Kp. Cohort isolation was applied and hygiene measures intensified. Due to poor compliance the KPC-Kp could spread further. In total 13 other patients proved to be colonized with KPC2-Kp, Environmental cultures also yielded KPC-Kp, despite extra cleaning.
Isolates expressed high-level resistance to all non-carbapenem beta-lactam antibiotics, aminoglycosides (exept for gentamycin), cotrimoxazol, aztreonam, and quinolones. MICs of imipenem and meropenem ranged from 1.5 to 32 microg/ml. MIC90 values for colistine and tigecycline were 1 microg/ml and 0.75 microg/ml, respectively.
Prior to acquisition, almost all patients were on TB medication, in some cases including moxifloxacine and amikacin. Most patients were asylum-seeker and originated from non-Europe countries. Some of the African patients travelled to The Netherlands via Greece where KPC-Kp is highly-endemic.
Conclusions: Social and cultural aspects of behaviour contributed to the poor hygiene-compliance of the patients involved in this first outbreak of KPC-Kp described in The Netherlands. Since treatment options for infections with KPC-producers are extremely limited, spread should be avoided. Strict infection control measurements are effective. To achieve more awareness, local and national surveillance is needed.