Successful Eradication of a Monoclonal Strain ofKlebsiella pneumoniaeduring aK. pneumoniaeCarbapenemase-ProducingK. pneumoniaeOutbreak in a Surgical Intensive Care Unit in Miami, Florida

Muñoz-Price, L. Silvia; Cuesta, Carolina De La; Adams, RN Stephen; Wyckoff, M.M.; Cleary, Timothy J.; McCurdy, Sandra P.; Huband, Michael D.; Lemmon, M. Megan; Lescoe, MaryKay; Dib-Hajj, Fadia; Hayden, Mary K.; Lolans, Karen; Quinn, John P.

doi:10.1086/656243

Cited by 58 publications

(46 citation statements)

References 12 publications

(16 reference statements)

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“…However, early data have suggested that combination therapy may be beneficial in bacteremia caused by KPC-producing K. pneumoniae (21). Rapid detection would therefore allow early examination of antimicrobial options and initiation of recommended infection control precautions to avert institutional outbreaks (22)(23)(24).…”

Section: Discussionmentioning

confidence: 99%

Pediatric Multicenter Evaluation of the Verigene Gram-Negative Blood Culture Test for Rapid Detection of Inpatient Bacteremia Involving Gram-Negative Organisms, Extended-Spectrum Beta-Lactamases, and Carbapenemases

et al. 2014

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We evaluated the investigational use only (IUO) version of the rapid Verigene Gram-negative blood culture test (BC-GN), a microarray that detects 9 genus/species targets (Acinetobacter spp., Citrobacter spp., Enterobacter spp., Escherichia coli/Shigella spp., Klebsiella oxytoca, Klebsiella pneumoniae, Proteus spp., Pseudomonas aeruginosa, and Serratia marcescens) and 6 antimicrobial resistance determinants (bla CTX-M , bla KPC , bla NDM , bla VIM , bla IMP , and bla OXA ) directly from positive blood cultures. BC-GN was performed on positive BacT/Alert Pediatric FAN and Bactec Peds Plus blood cultures with Gram-negative organisms at two tertiary pediatric centers. Vitek MS (bioMérieux, Durham, NC) was used to assign gold standard organism identification. The Check MDR CT-102 microarray (Check Points B.V., Wageningen, Netherlands) was used as an alternative method for detecting resistance determinants. In total, 104 organisms were isolated from 97 clinical blood cultures. BC-GN correctly detected 26/26 cultures with Acinetobacter spp., P. aeruginosa, and S. marcescens, 5/6 with Citrobacter spp., 13/14 with Enterobacter spp., 23/24 with E. coli, 2/3 with K. oxytoca, 16/17 with K. pneumoniae, and 0/1 with Proteus spp. BC-GN appropriately reported negative BC-GN results in 8/13 blood cultures that grew organisms that were not represented on the microarray but failed to detect targets in 3/5 cultures that grew multiple Gram-negative organisms. BC-GN detected 5/5 and 1/1 clinical blood cultures with bla CTX-M and bla VIM . All 6 results were corroborated by Check MDR CT-102 microarray testing. The Verigene BC-GN test has the potential to expedite therapeutic decision making in pediatric patients with Gram-negative bacteremia. Sensitivity was satisfactory but may be suboptimal in mixed Gram-negative blood cultures.

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Section: Discussionmentioning

confidence: 99%

Pediatric Multicenter Evaluation of the Verigene Gram-Negative Blood Culture Test for Rapid Detection of Inpatient Bacteremia Involving Gram-Negative Organisms, Extended-Spectrum Beta-Lactamases, and Carbapenemases

et al. 2014

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“…Isolation or cohorting of CPE carriers seems to be the main prevention measure (43,83,106,110,122,127,176,177,234). Assignment of dedicated health care workers and use of separate equipment for carriers are additional interventions that have been employed successfully in several outbreaks (19,43,122,176,177,234).…”

Section: Interventionmentioning

confidence: 99%

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

et al. 2012

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SUMMARY The spread of Enterobacteriaceae , primarily Klebsiella pneumoniae , producing KPC, VIM, IMP, and NDM carbapenemases, is causing an unprecedented public health crisis. Carbapenemase-producing enterobacteria (CPE) infect mainly hospitalized patients but also have been spreading in long-term care facilities. Given their multidrug resistance, therapeutic options are limited and, as discussed here, should be reevaluated and optimized. Based on susceptibility data, colistin and tigecycline are commonly used to treat CPE infections. Nevertheless, a review of the literature revealed high failure rates in cases of monotherapy with these drugs, whilst monotherapy with either a carbapenem or an aminoglycoside appeared to be more effective. Combination therapies not including carbapenems were comparable to aminoglycoside and carbapenem monotherapies. Higher success rates have been achieved with carbapenem-containing combinations. Pharmacodynamic simulations and experimental infections indicate that modification of the current patterns of carbapenem use against CPE warrants further attention. Epidemiological data, though fragmentary in many countries, indicate CPE foci and transmission routes, to some extent, whilst also underlining the lack of international collaborative systems that could react promptly and effectively. Fortunately, there are sound studies showing successful containment of CPE by bundles of measures, among which the most important are active surveillance cultures, separation of carriers, and assignment of dedicated nursing staff.

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“…In another study, Enfield et al were successful in decreasing the CPE incidence in a surgical ICU from 7.77 cases per 1,000 patient-days to 1.22 cases per 1,000 patient-days by using enhanced infection control measures and increased surveillance by implementing a PCR-based assay (82). Two outbreaks of KPCproducing organisms were successfully controlled by using a "bundle approach," of which screening for CPE carriage is an integral part (83,84). Schwaber et al reported on a country-wide mandatory program involving physical isolation and dedicated nursing staff in Israel that was able to significantly decrease the incidence of KPC-producing isolates (85).…”

Section: Intestinal Carriage Of Cposmentioning

confidence: 99%

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

et al. 2016

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SUMMARYCarbapenemases have become a significant mechanism for broad-spectrum β-lactam resistance inEnterobacteriaceaeand other Gram-negative bacteria such asPseudomonasandAcinetobacterspp. Intestinal carriage of carbapenemase-producing organisms (CPOs) is an important source of transmission. Isolation of carriers is one strategy that can be used to limit the spread of these bacteria. In this review, we critically examine the clinical performance, advantages, and disadvantages of methods available for the detection of intestinal carriage of CPOs. Culture-based methods (Centers for Disease Control and Prevention [CDC] protocols, chromogenic media, specialized agars, and double-disk synergy tests) for detecting carriage of CPOs are convenient due to their ready availability and low cost, but their limited sensitivity and long turnaround time may not always be optimal for infection control practices. Contemporary nucleic acid amplification techniques (NAATs) such as real-time PCR, hybridization assays, loop-mediated isothermal amplification (LAMP), or a combined culture and NAAT approach may provide fast results and/or added sensitivity and specificity compared with culture-based methods. Infection control practitioners and clinical microbiologists should be aware of the strengths and limitations of available methods to determine the most suitable approach for their medical facility to fit their infection control needs.

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Successful Eradication of a Monoclonal Strain ofKlebsiella pneumoniaeduring aK. pneumoniaeCarbapenemase-ProducingK. pneumoniaeOutbreak in a Surgical Intensive Care Unit in Miami, Florida

Cited by 58 publications

References 12 publications

Pediatric Multicenter Evaluation of the Verigene Gram-Negative Blood Culture Test for Rapid Detection of Inpatient Bacteremia Involving Gram-Negative Organisms, Extended-Spectrum Beta-Lactamases, and Carbapenemases

Pediatric Multicenter Evaluation of the Verigene Gram-Negative Blood Culture Test for Rapid Detection of Inpatient Bacteremia Involving Gram-Negative Organisms, Extended-Spectrum Beta-Lactamases, and Carbapenemases

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

Intestinal Carriage of Carbapenemase-Producing Organisms: Current Status of Surveillance Methods

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