Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing

Zhongqiang Yan; Yu Zhou; Mingmei Du; Yanling Bai; Bowei Liu; Meiliang Gong; Hongbin Song; Yigang Tong; Yunxi Liu

doi:10.1016/j.jhin.2018.11.019

Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing

J Hosp Infect. 2019 Feb;101(2):150-157. doi: 10.1016/j.jhin.2018.11.019. Epub 2018 Dec 6.

Authors

Zhongqiang Yan¹, Yu Zhou², Mingmei Du³, Yanling Bai³, Bowei Liu³, Meiliang Gong², Hongbin Song⁴, Yigang Tong⁵, Yunxi Liu⁶

Affiliations

¹ Department of Nanlou Nosocomial Infection Management, Chinese PLA General Hospital, Beijing, China.
² Department of Nanlou Clinical Laboratory, Chinese PLA General Hospital, Beijing, China.
³ Department of Nosocomial Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China.
⁴ Institute for Disease Control and Prevention of PLA, Beijing, China.
⁵ State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
⁶ Department of Nosocomial Infection Management and Disease Control, Chinese PLA General Hospital, Beijing, China. Electronic address: 1583279351@qq.com.

PMID: 30529506
DOI: 10.1016/j.jhin.2018.11.019

Abstract

Background: Following the alarming outbreak of carbapenem-resistant Klebsiella pneumonia (CRKP) in five intensive care units (ICUs) of a tertiary care hospital in China, a prospective investigation of CRKP colonized/infected patients was conducted.

Aim: To describe the diffusion and transmission of CRKP among epidemiologically linked ICU patients, staff and environment.

Methods: Enhanced CRKP infected/colonized case monitoring was performed by the real-time nosocomial infection surveillance system (RT-NISS). The immediate surroundings of each CRKP patient bed unit and the staff hands/gloves/gowns were sampled and then evaluated for the presence of CRKP. Antimicrobial susceptibility tests, pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) were used to identify and to characterize these isolates.

Findings: Among 2750 patients monitored, 67 CRKP patients were newly labeled and 11 patients' CRKP isolates were available. A total of 31.34% (21/67) bed units were positive at one or more surrounding surfaces, 7.99% (49/613) environmental samples and 3.57% (4/112) ICU staff samples were CRKP positive. The selected CRKP isolates (N = 64) exhibited intermediate to high resistance levels to the antibiotics tested apart from colistin and tigecycline. RT-NISS data combined with MLST and PFGE revealed nine likely transmission clusters. WGS analysis of these CRKP isolates revealed extensive sharing of multiple antimicrobial resistance genes and plasmid replicons among these isolates. Two carbapenemase genes bla_KPC-2 (62/64) and bla_OXA-48 (2/64) were identified. These CRKP isolates carried one or more plasmid replicons.

Conclusions: The contamination of ICU environment and staff's hands, gloves or gowns is frequent with CRKP patients. Our study also supports the hypothesis that an association between environmental contamination and transmission of CRKP bacteria in ICUs.

Keywords: Carbapenem-resistant Klebsiella pneumonia; Environmental contamination; Intensive care unit; Staff; Transmission; Whole-genome sequencing.

MeSH terms

Anti-Bacterial Agents / pharmacology
Beijing / epidemiology
Carbapenem-Resistant Enterobacteriaceae / classification
Carbapenem-Resistant Enterobacteriaceae / drug effects
Carbapenem-Resistant Enterobacteriaceae / genetics
Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
Cross Infection / epidemiology*
Cross Infection / microbiology
Cross Infection / transmission
Disease Transmission, Infectious*
Drug Resistance, Bacterial
Electrophoresis, Gel, Pulsed-Field
Environmental Microbiology*
Gloves, Protective / microbiology
Hand / microbiology
Humans
Intensive Care Units
Klebsiella Infections / epidemiology*
Klebsiella Infections / microbiology
Klebsiella Infections / transmission
Klebsiella pneumoniae / classification
Klebsiella pneumoniae / drug effects
Klebsiella pneumoniae / genetics
Klebsiella pneumoniae / isolation & purification*
Microbial Sensitivity Tests
Molecular Typing
Plasmids / analysis
Prospective Studies
Tertiary Care Centers
Whole Genome Sequencing

Substances

Anti-Bacterial Agents