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Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Background: Klebsiella pneumoniae carbapenemases (KPC) are enzymes that confer resistance against most beta-lactams. Despite having been identified worldwide, studies describing successful control of KPC outbreaks are few.
Objective: Characterization of the epidemiology and infection control measures of a KPC-producing K. pneumoniae outbreak.
Methods: The intervention was conducted at a 1,500 bed public, urban, teaching hospital in theMiami metro area. Using the Microbiology database, all ertapenem resistant K. pneumoniae obtained from clinical specimens from January 1, 2009 to November 1, 2009 were identified. Additionally, 2 point prevalence surveys (using rectal cultures) were performed. Environmental cultures were also obtained.
Ertapenem-resistant enteric Gram negative rods identified by Vitek II underwent a modified Hodge test, KPC PCR and PFGE. Colistin susceptibilities were done by broth microdilution.
Because all infections were identified in the SICU, a bundle intervention was enforced in this unit on 7/10/09 consisting of daily 2% chlorhexidine baths, point prevalence surveys and environmental cultures, enhanced environmental cleaning, contact precautions, and staff education. One-to-one ratio was implemented among all environmental, respiratory, and nursing personnel assigned to KPC rooms.
Results: Between January 1 and November 1, 2009 a total of 9 patients (7 men) carrying KPC-producing K. pneumoniae were identified in the SICU. Six patients were identified prior to the bundle intervention. The last KPC was identified on August 11, 2009. Median age of patients was 60 yrs (range: 25-75). Length of stay ranged from 15 to 150 days (mean, 84.2). Seven of 9 pts (77.7%) underwent surgical intervention during their admission, and 5/9 (71.4%) had solid organ transplants (2 liver, 1 kidney, 1 pancreas, 1 multi-visceral). The mean Apache II score was 18.3 (range, 7-28) and the Charlson comorbidity index ranged between 1-7 (mean, 5.3). A total of 6 patients (67%) died during hospitalization; 1 is still hospitalized. Four of 9 patients died from sepsis. Subsequent rectal surveys done in 8/09 among all SICU patients failed to show colonization with KPC producing enteric Gram negative rods.
KPC K. pneumoniae strains were isolated from the lungs (5), abdominal fluid (2), blood (1) and urine (1). These strains were also isolated from mattresses, bed rails, ventilator tubing, intravenous pole, vitals monitors and TV monitors. Nine clinical isolates underwent KPC PCR and PFGE. All K. pneumoniae were found to be monoclonal KPC-3 producers. Colistin susceptibilities were <=1, except in one isolate which had an MIC of 16. Additionally, an imipenem-resistant Pseudomonas aeruginosa found during one rectal survey was found to be KPC-3 producer.
Conclusions: A monoclonal KPC-3 producing K. pneumoniae outbreak in a SICU was successfully controlled by a bundle intervention.
Objective: Characterization of the epidemiology and infection control measures of a KPC-producing K. pneumoniae outbreak.
Methods: The intervention was conducted at a 1,500 bed public, urban, teaching hospital in the
Ertapenem-resistant enteric Gram negative rods identified by Vitek II underwent a modified Hodge test, KPC PCR and PFGE. Colistin susceptibilities were done by broth microdilution.
Because all infections were identified in the SICU, a bundle intervention was enforced in this unit on 7/10/09 consisting of daily 2% chlorhexidine baths, point prevalence surveys and environmental cultures, enhanced environmental cleaning, contact precautions, and staff education. One-to-one ratio was implemented among all environmental, respiratory, and nursing personnel assigned to KPC rooms.
Results: Between January 1 and November 1, 2009 a total of 9 patients (7 men) carrying KPC-producing K. pneumoniae were identified in the SICU. Six patients were identified prior to the bundle intervention. The last KPC was identified on August 11, 2009. Median age of patients was 60 yrs (range: 25-75). Length of stay ranged from 15 to 150 days (mean, 84.2). Seven of 9 pts (77.7%) underwent surgical intervention during their admission, and 5/9 (71.4%) had solid organ transplants (2 liver, 1 kidney, 1 pancreas, 1 multi-visceral). The mean Apache II score was 18.3 (range, 7-28) and the Charlson comorbidity index ranged between 1-7 (mean, 5.3). A total of 6 patients (67%) died during hospitalization; 1 is still hospitalized. Four of 9 patients died from sepsis. Subsequent rectal surveys done in 8/09 among all SICU patients failed to show colonization with KPC producing enteric Gram negative rods.
KPC K. pneumoniae strains were isolated from the lungs (5), abdominal fluid (2), blood (1) and urine (1). These strains were also isolated from mattresses, bed rails, ventilator tubing, intravenous pole, vitals monitors and TV monitors. Nine clinical isolates underwent KPC PCR and PFGE. All K. pneumoniae were found to be monoclonal KPC-3 producers. Colistin susceptibilities were <=1, except in one isolate which had an MIC of 16. Additionally, an imipenem-resistant Pseudomonas aeruginosa found during one rectal survey was found to be KPC-3 producer.
Conclusions: A monoclonal KPC-3 producing K. pneumoniae outbreak in a SICU was successfully controlled by a bundle intervention.