Frequency of <i>Klebsiella pneumoniae</i> Carbapenemase (KPC)–Producing and Non-KPC-Producing <i>Klebsiella</i> Species Contamination of Healthcare Workers and the Environment

Rock, Clare; Thom, Kerri A.; Masnick, Max; Johnson, J. Kristie; Harris, Anthony D.; Morgan, Daniel J.

doi:10.1086/675598

Cited by 76 publications

(76 citation statements)

References 4 publications

(10 reference statements)

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“…Antimicrobial-impregnated textiles may be more effective in settings with potentially prolonged exposure and activity, including curtains and linens. 11,18 Our study confirmed that HCP clothing regularly becomes contaminated with important pathogens 6,19,20 and, as a result, can act as a source for transmission. For example, in a cohort study of 57 nurses, approximately half of the nurses' surgical scrubs became contaminated with VRE, MRSA, and/or C. difficile by the end of a standard shift.…”

Section: Discussionsupporting

confidence: 71%

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination

Anderson

Addison

Lokhnygina

et al. 2017

Infect. Control Hosp. Epidemiol.

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objective. To determine whether antimicrobial-impregnated textiles decrease the acquisition of pathogens by healthcare provider (HCP) clothing.design. We completed a 3-arm randomized controlled trial to test the efficacy of 2 types of antimicrobial-impregnated clothing compared to standard HCP clothing. Cultures were obtained from each nurse participant, the healthcare environment, and patients during each shift. The primary outcome was the change in total contamination on nurse scrubs, measured as the sum of colony-forming units (CFU) of bacteria.participants and setting. Nurses working in medical and surgical ICUs in a 936-bed tertiary-care hospital.intervention. Nurse subjects wore standard cotton-polyester surgical scrubs (control), scrubs that contained a complex element compound with a silver-alloy embedded in its fibers (Scrub 1), or scrubs impregnated with an organosilane-based quaternary ammonium and a hydrophobic fluoroacrylate copolymer emulsion (Scrub 2). Nurse participants were blinded to scrub type and randomly participated in all 3 arms during 3 consecutive 12-hour shifts in the intensive care unit.results. In total, 40 nurses were enrolled and completed 3 shifts. Analyses of 2,919 cultures from the environment and 2,185 from HCP clothing showed that scrub type was not associated with a change in HCP clothing contamination (P = .70). Mean difference estimates were 0.118 for the Scrub 1 arm (95% confidence interval [CI], −0.206 to 0.441; P = .48) and 0.009 for the Scrub 2 rm (95% CI, −0.323 to 0.342; P = .96) compared to the control. HCP became newly contaminated with important pathogens during 19 of the 120 shifts (16%).conclusions. Antimicrobial-impregnated scrubs were not effective at reducing HCP contamination. However, the environment is an important source of HCP clothing contamination. trial registration. Clinicaltrials.gov Identifier: NCT 02645214

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Section: Discussionsupporting

confidence: 71%

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination

Anderson

Addison

Lokhnygina

et al. 2017

Infect. Control Hosp. Epidemiol.

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“…K. pneumoniae was first isolated in the late 19th century and was initially known as Friedlander's bacterium (1,2). It is a Gram-negative, encapsulated, nonmotile bacterium that resides in the environment, including in soil and surface waters and on medical devices (3,4). Importantly, K. pneumoniae readily colonizes human mucosal surfaces, including the gastrointestinal (GI) tract and oropharynx, where the effects of its colonization appear benign (3)(4)(5).…”

mentioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,222

1,345

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SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

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“…Often by acquiring mobile resistance elements through horizontal gene transfer, CRE infections are especially threatening because they approach pan-resistance, frequently delaying and greatly reducing successful therapeutic treatment options for invasive infections. These bacteria harboring mobile carbapenemase genes are now identified with some regularity from both hospital-and community-acquired human infections (4) and have been recovered from health care environments (5), waste and surface water flows, soil, and companion animals (6,7).…”

mentioning

confidence: 99%

Carbapenemase-Producing Enterobacteriaceae Recovered from the Environment of a Swine Farrow-to-Finish Operation in the United States

Mollenkopf

Stull

Mathys

et al. 2017

Antimicrob Agents Chemother

105

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Carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to public health. While use of carbapenem antimicrobials is restricted for foodproducing animals, other ␤-lactams, such as ceftiofur, are used in livestock. This use may provide selection pressure favoring the amplification of carbapenem resistance, but this relationship has not been established. Previously unreported among U.S. livestock, plasmid-mediated CRE have been reported from livestock in Europe and Asia. In this study, environmental and fecal samples were collected from a 1,500-sow, U.S. farrow-to-finish operation during 4 visits over a 5-month period in 2015. Samples were screened using selective media for the presence of CRE, and the resulting carbapenemase-producing isolates were further characterized. Of 30 environmental samples collected from a nursery room on our initial visit, 2 (7%) samples yielded 3 isolates, 2 sequence type 218 (ST 218) Escherichia coli and 1 Proteus mirabilis, carrying the metallo-␤-lactamase gene bla IMP-27 on IncQ1 plasmids. We recovered on our third visit 15 IMP-27-bearing isolates of multiple Enterobacteriaceae species from 11 of 24 (46%) environmental samples from 2 farrowing rooms. These isolates each also carried bla IMP-27 on IncQ1 plasmids. No CRE isolates were recovered from fecal swabs or samples in this study. As is common in U.S. swine production, piglets on this farm receive ceftiofur at birth, with males receiving a second dose at castration (Ϸday 6). This selection pressure may favor the dissemination of bla IMP-27 -bearing Enterobacteriaceae in this farrowing barn. The absence of this selection pressure in the nursery and finisher barns likely resulted in the loss of the ecological niche needed for maintenance of this carbapenem resistance gene.

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Frequency of Klebsiella pneumoniae Carbapenemase (KPC)–Producing and Non-KPC-Producing Klebsiella Species Contamination of Healthcare Workers and the Environment

Cited by 76 publications

References 4 publications

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination

The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Carbapenemase-Producing Enterobacteriaceae Recovered from the Environment of a Swine Farrow-to-Finish Operation in the United States

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