The Washing Machine as a Reservoir for Transmission of Extended-Spectrum-Beta-Lactamase (CTX-M-15)-Producing Klebsiella oxytoca ST201 to Newborns

Schmithausen, Ricarda Maria; Sib, Esther; Exner, Martin; Hack, Sylvia; Rösing, Claudia; Ciorba, Patrick; Bierbaum, Gabriele; Savin, Mykhailo; Bloomfield, Sally F.; Kaase, Martin; Jacobshagen, Anja; Gemein, Stefanie; Gebel, Jürgen; Engelhart, Steffen; Exner, Daniel

doi:10.1128/aem.01435-19

Cited by 49 publications

(42 citation statements)

References 36 publications

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“…Klebsiella spp. are known to accumulate polymorphisms that confer growth advantages allowing them to persist in the hospital environment [35,36]. In addition, K. oxytoca is frequently resistant to ampicillin which is commonly provided to premature infants.…”

Section: Discussionmentioning

confidence: 99%

Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis

Paveglio

Ledala

Rezaul

et al. 2020

Emerging Microbes & Infections

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Necrotizing enterocolitis (NEC) is a devastating intestinal inflammatory disease of premature infants associated with gut bacterial dysbiosis. Using 16S rRNA-based methods, our laboratory identified an unclassified Enterobacteriaceae sequence (NEC_unk_OTU) with high abundance in NEC fecal samples. We aimed to identify this bacterium and determine its potential role in the disease. NCBI database searches for the 16S sequence, selective culture systems, biotyping and polymerase chain reaction were employed to refine classification of NEC_unk_OTU and identify toxinencoding genes from the index NEC case. Bacterial cytotoxin production was confirmed by mass spectrometry and apoptosis assays. Additional fecal samples from 9 NEC and 5 non-NEC controls were analyzed using similar methods and multi-locus sequence typing (MLST) was performed to investigate clonal relationships and define sequence types of the isolates. NEC_unk_OTU was identified as Klebsiella oxytoca, a pathobiont known to cause antibiotic-associated hemorrhagic colitis, but not previously linked to NEC. Including the index case, cytotoxin-producing strains of K. oxytoca were isolated from 6 of 10 subjects with NEC; in these, the K. oxytoca 16S sequence predominated the fecal microbiota. Cytotoxin-producing strains of K. oxytoca also were isolated from 4 of 5 controls; in these, however, the abundance of the corresponding 16S sequence was very low. MLST analysis of the toxin-positive isolates demonstrated no clonal relationships and similar genetic clustering between cases and controls. These results suggest cytotoxin-producing strains of K. oxytoca colonize a substantial proportion of premature infants. Some, perhaps many, cases of NEC may be precipitated by outgrowth of this opportunistic pathogen.

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Section: Discussionmentioning

confidence: 99%

Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis

Paveglio

Ledala

Rezaul

et al. 2020

Emerging Microbes & Infections

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“…(2) Since characterization, K. michiganensis has been reported in clinical settings, including as a cause of diarrhea in a hematopoietic stem cell transplant recipient (3), from a sample of fluid from an abdominal fistula (4), in an investigation of hospital-acquired colonization by a New Delhi metallo-βlactamase-producing organism (5) and as an invasive, Klebsiella pneumoniae carbapenemase (KPC)-producing pathogen causing bloodstream infection (6). While the role of K. oxytoca in nosocomial outbreaks is established (7)(8)(9)(10)(11), there have been no reported outbreaks involving K. michiganensis to date. Similar to K. oxytoca, K. michiganensis carries a chromosomally-encoded OXY-type (Ambler class A) β-lactamase (12,13) (also labelled as K1 in K. oxytoca (14)) which mediates resistance to amino-and carboxy-penicillins (e.g.…”

Section: Introductionmentioning

confidence: 99%

Genomic investigation reveals contaminated detergent as the source of an ESBL-producing Klebsiella michiganensis outbreak in a neonatal unit

Chapman

Forde

Roberts

et al. 2019

Preprint

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Key points:• K. michiganensis can be misidentified as K. oxytoca and is probably underrecognized as a nosocomial pathogen• Whole genome sequencing of neonatal and environmental isolates during an outbreak of ESBL-producing K. michiganensis confirmed contaminated detergent and sinks to be the source Abstract Background: Klebsiella species are problematic pathogens in neonatal units and may cause outbreaks, for which sources of transmission can be challenging to elucidate. We describe the use of whole genome sequencing (WGS) to investigate environmental sources of transmission during an outbreak of extended-spectrum-βlactamase (ESBL)-producing Klebsiella michiganensis colonizing neonates. Methods: Ceftriaxone-resistant Klebsiella spp. isolated from neonates (or their mothers) and the hospital environment were included. Short-read (Illumina) and longread (MinION, Oxford Nanopore Technologies) sequencing was used to confirm species taxonomy, define antimicrobial resistance genes and determine phylogenetic relationships using single nucleotide polymorphism (SNP) profiling. Results: A total of 21 organisms (10 patient-derived and 11 environmental isolates) were sequenced. Standard laboratory methods identified the outbreak strain as an ESBL-producing Klebsiella oxytoca, but taxonomic assignment from WGS data suggested closer identity to Klebsiella michiganensis. Strains isolated from baby bath drains and multiple detergent dispensing bottles were either identical or closely related by SNP comparison. Detergent bottles contaminated by K. michiganensis had been used for washing milk-expressing equipment. No new cases were identified once the detergent bottles were removed and the baby baths decommissioned. Conclusions: Environmental reservoirs may be an important source in outbreaks of multi-drug resistant organisms. WGS, in conjunction with traditional epidemiological investigation, can be instrumental in revealing routes of transmission and guiding infection control responses. (214 words)

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“…The potential role of laundering in transmission of bacteria is reasoned upon in several studies, and a few outbreaks with Bacillus cereus via hospital linen with the potential role of washing machines have been described. [25][26][27] However, no studies on outbreaks with multidrug-resistant Enterobacteriaceae via a household washing machine had been described until recently, when Schmithausen et al 28 published a report about the transmission of ESBL-K. oxytoca among newborns.…”

Section: Discussionmentioning

confidence: 99%

An outbreak of ST307 extended-spectrum beta-lactamase (ESBL)–producingKlebsiella pneumoniaein a rehabilitation center: An unusual source and route of transmission

Boonstra

Spijkerman

holt

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective:Nosocomial outbreaks due to multidrug-resistant microorganisms in rehabilitation centers have rarely been reported. We report an outbreak of extended-spectrum beta-lactamase (ESBL)–producing Klebsiella pneumoniae (ESBL-K. pneumoniae) on a single ward in a rehabilitation center in Rotterdam, The Netherlands.Design:Outbreak description.Setting:A 40-bed ward of a rehabilitation center in the Netherlands.Methods:In October 2016, 2 patients were found to be colonized by genetically indistinguishable ESBL-K. pneumoniae isolates. Therefore, an outbreak management team was installed, by whom a contact tracing plan was made. In addition to general outbreak measures, specific measures were formulated to allow continuation of the rehabilitation process. Also, environmental cultures were taken. Multiple-locus variable-number tandem-repeat analysis and amplification fragment-length polymorphism were used to determine strain relatedness. Selected isolates were subjected to whole-genome multilocus sequence typing.Results:The outbreak lasted 8 weeks. In total, 14 patients were colonized with an ESBL-K. pneumoniae, of whom 11 patients had an isolate belonging to sequence type 307. Overall, 163 environmental cultures were taken. Several sites of a household washing machine were repeatedly found to be contaminated with the outbreak strain. This machine was used to wash lifting slings and patient clothing contaminated with feces. The outbreak was contained after taking the machine temporarily out of service and implementing a reinforced and adapted protocol on the use of this machine.Conclusion:We conclude that in this outbreak, the route of transmission of the outbreak strain via the household washing machine played a major role.

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The Washing Machine as a Reservoir for Transmission of Extended-Spectrum-Beta-Lactamase (CTX-M-15)-Producing Klebsiella oxytoca ST201 to Newborns

Cited by 49 publications

References 36 publications

Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis

Cytotoxin-producing Klebsiella oxytoca in the preterm gut and its association with necrotizing enterocolitis

Genomic investigation reveals contaminated detergent as the source of an ESBL-producing Klebsiella michiganensis outbreak in a neonatal unit

An outbreak of ST307 extended-spectrum beta-lactamase (ESBL)–producingKlebsiella pneumoniaein a rehabilitation center: An unusual source and route of transmission

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