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Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)–producing Enterobacteriaceae outbreak

Published online by Cambridge University Press:  14 May 2019

Allison E. Reeme ,
Sarah L. Bowler ,
Blake W. Buchan ,
Mary Beth Graham ,
Elizabeth Behrens ,
Siddhartha Singh ,
Johnny C. Hong ,
Jennifer Arvan ,
Joshua W. Hyke  and
Louis Palen
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Allison E. Reeme
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Sarah L. Bowler
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Blake W. Buchan
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Mary Beth Graham
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Elizabeth Behrens
Affiliation:
Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Siddhartha Singh
Affiliation:
Division of General Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
Johnny C. Hong
Affiliation:
Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
Jennifer Arvan
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Joshua W. Hyke
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Louis Palen
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Sabrina Savage
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Heather Seliger
Affiliation:
Department of Infection Prevention and Control, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Susan Huerta
Affiliation:
Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
Nathan A. Ledeboer
Affiliation:
Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
Shireen Kotay
Affiliation:
Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia
Amy J. Mathers
Affiliation:
Division of Infectious Diseases, University of Virginia, Charlottesville, Virginia
Vaughn S. Cooper
Affiliation:
Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania
Mustapha Munir Mustapha
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Roberta T. Mettus
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Yohei Doi
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
L. Silvia Munoz-Price*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
*
Author for correspondence: L. Silvia Munoz-Price, Email: smunozprice@mcw.edu
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Abstract

Objective:

Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.

Design:

Observational study.

Setting:

A 566-room academic teaching facility in Milwaukee, Wisconsin.

Patients:

Solid-organ transplant recipients.

Methods:

Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.

Results:

A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.

Conclusions:

A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 7 , July 2019 , pp. 767 - 773
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved 

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