Transfer of Carbapenem-Resistant Plasmid from<i>Klebsiella pneumoniae</i>ST258 to<i>Escherichia coli</i>in Patient

Goren, Moran G.; Carmeli, Yehuda; Schwaber, Mitchell J.; Chmelnitsky, Inna; Schechner, Vered; Navon-Venezia, Shiri

doi:10.3201/eid1606.091671

Cited by 127 publications

(107 citation statements)

References 15 publications

(23 reference statements)

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“…In contrast, if the contact had KPC-producing E. coli and the index had KPC-producing K. pneumoniae, then the contact was included as a having a case of CP-CRE, based on the assumption that he acquired KPC by horizontal gene transfer. [12][13][14] In a few cases, K. pneumoniae isolates from the index patients were identified at another institution as carbapenemase producers by means of modified Hodge test without polymerase chain reaction testing (PCR). For this study, they were assumed to be bla KPC positive, because, during the study period, bla KPC was almost exclusively the mechanism of resistance among carbapenemase-producing K. pneumoniae in Israel.…”

Section: Microbiological Methodsmentioning

confidence: 99%

“…3,9,10 Molecular studies have demonstrated how clonal expansion and horizontal plasmid dissemination, either within the same species or, rarely, between species, underlie the spread of these multidrug-resistant pathogens. [11][12][13][14] Strict contact isolation, physical separation of carriers from noncarriers, and use of dedicated staff are key components in containing CP-CRE in acute care hospitals. 15 Active surveillance to promptly detect (and isolate) asymptomatic carriers is important measure to curtail transmission to other patients, as clinical cultures detect only a small portion of these carriers.…”

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confidence: 99%

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Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

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Section: Microbiological Methodsmentioning

confidence: 99%

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confidence: 99%

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…Plasmid DNA from the nine ERCNKP clone Q isolates was extracted and studied by S1 analysis (23). All representative plasmids (according to size) were gel extracted as previously described (42) for further individual analysis.…”

Section: Methodsmentioning

confidence: 99%

A Swordless Knight: Epidemiology and Molecular Characteristics of the bla _KPC -Negative Sequence Type 258 Klebsiella pneumoniae Clone

et al. 2012

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cIn June 2010, a bla KPC -negative, ertapenem-resistant ST-258 Klebsiella pneumoniae strain was isolated from a patient in the Laniado Medical Center (LMC). Our aims were (i) to describe its molecular characteristics and resistance mechanisms and (ii) to assess whether the bla KPC -negative ST-258 K. pneumoniae clone spreads as efficiently as its KPC-producing isogenic strain. In a prospective study, surveillance of all ertapenem-resistant, carbapenemase-negative K. pneumoniae (

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“…Transformants were selected on LB agar supplemented with cefazolin (8 mg/liter) and confirmed by bla OXA-48 PCR. Determinations of plasmid size and restriction fragment length polymorphism (RFLP) were done as previously described (20). The genetic environment of bla OXA-48 was studied by PCR and sequencing (1).…”

Section: Setup and Designmentioning

confidence: 99%

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

et al. 2013

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dThis study describes the course of an OXA-48-producing Enterobacteriaceae (OPE) outbreak that started in March 2012 in a neonatal intensive care unit (NICU) in Jerusalem, Israel. During the peak of the outbreak (January to August 2012), there were 49 patients who had proven or suspected acquisition of OPE in the NICU, including 16 with invasive infections, out of a total of 156 patients who were hospitalized during that period. Three children hospitalized in the pediatric ICU were identified as carriers of OPE. Three patients with a previous stay in the affected NICU were identified as OPE carriers upon admission to another hospital. The Ministry of Health was notified and then intervened in July 2012. Intervention included cohorting colonized patients, conducting frequent rectal-culture surveillance, and improving the implementation of infection control practices. As a result, the incidence of OPE acquisition declined to 5 cases in the first 4 months, followed by no new cases in the next 3 months. Thirty-one patient-unique isolates were available for analysis: 29 Klebsiella pneumoniae isolates, all belonging to a single clone (sequence type 39 [ST39]), and 2 isolates from Enterobacter cloacae. All isolates possessed the bla OXA-48 and bla CTX-M-14 genes, which are located on the same plasmid. This plasmid, similar to the global bla OXA-48 -harboring vector, has now acquired bla CTX-M-14 , leading to resistance to all ␤-lactam agents.

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Transfer of Carbapenem-Resistant Plasmid fromKlebsiella pneumoniaeST258 toEscherichia coliin Patient

Cited by 127 publications

References 15 publications

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

A Swordless Knight: Epidemiology and Molecular Characteristics of the bla _KPC -Negative Sequence Type 258 Klebsiella pneumoniae Clone

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

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Transfer of Carbapenem-Resistant Plasmid fromKlebsiella pneumoniaeST258 toEscherichia coliin Patient

Cited by 127 publications

References 15 publications

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

A Swordless Knight: Epidemiology and Molecular Characteristics of the bla KPC -Negative Sequence Type 258 Klebsiella pneumoniae Clone

Epidemiological and Microbiological Characteristics of an Outbreak Caused by OXA-48-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Jerusalem, Israel

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A Swordless Knight: Epidemiology and Molecular Characteristics of the bla _KPC -Negative Sequence Type 258 Klebsiella pneumoniae Clone