Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida

Infect Control Hosp Epidemiol. 2017 Mar;38(3):320-326. doi: 10.1017/ice.2016.273. Epub 2016 Dec 7.

Abstract

OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase-producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase-3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak. Infect Control Hosp Epidemiol 2017;38:320-326.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Proteins / biosynthesis
  • Citrobacter freundii / enzymology
  • Citrobacter freundii / isolation & purification*
  • Cross Infection / epidemiology
  • Disease Outbreaks*
  • Enterobacteriaceae Infections / epidemiology*
  • Female
  • Florida
  • Humans
  • Infection Control / methods
  • Intensive Care Units / standards
  • Klebsiella pneumoniae / enzymology*
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Tertiary Care Centers
  • Young Adult
  • beta-Lactamases / biosynthesis

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-Lactamases
  • carbapenemase