Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures

David Peres; Paulo Figueiredo; Paulo Andrade; Nuno Rocha-Pereira; Cláudia Carvalho; Rita Ferraz; Raquel Duro; Arnaldo Dias; Abel Gomes; Cláudia Pereira; Gisélia Braga; Virginia Pereira; Lino Azevedo; Edgar Moniz; Manuela Ribeiro; Eugénia Ferreira; Vera Manageiro; José Teixeira; Tiago Guimarães; Manuela Caniça; Carlos Alves

doi:10.1097/j.pbj.0000000000000186

Outbreak of KPC-producing Klebsiella pneumoniae at a Portuguese university hospital: Epidemiological characterization and containment measures

Porto Biomed J. 2022 Dec 1;7(6):e186. doi: 10.1097/j.pbj.0000000000000186. eCollection 2022 Nov-Dec.

Authors

David Peres¹, Paulo Figueiredo^{2

3}, Paulo Andrade^{2

3}, Nuno Rocha-Pereira^{2

3}, Cláudia Carvalho^{2

3}, Rita Ferraz^{2

3}, Raquel Duro^{2

3}, Arnaldo Dias², Abel Gomes², Cláudia Pereira², Gisélia Braga², Virginia Pereira⁴, Lino Azevedo⁵, Edgar Moniz⁵, Manuela Ribeiro⁵, Eugénia Ferreira⁶, Vera Manageiro⁶, José Teixeira⁴, Tiago Guimarães⁵, Manuela Caniça⁶, Carlos Alves^{2

3}

Affiliations

¹ Infection and Antimicrobial Resistance Prevention and Control Unit, Matosinhos Local Health Unit, Matosinhos, Portugal.
² Infection and Antimicrobial Resistance Prevention and Control Unit, Centro Hospitalar Universitário São João, Porto, Portugal.
³ Infectious Diseases Department, Centro Hospitalar Universitário São João, Porto, Portugal.
⁴ Vascular Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal.
⁵ Microbiology Laboratory, Centro Hospitalar Universitário São João, Porto, Portugal.
⁶ National Reference Laboratory of Antibiotic Resistances and Healthcare Associated Infections, National Institute of Health Doutor Ricardo Jorge, Lisbon, Portugal.

Abstract

Background: KPC-producing K pneumoniae (KPC-Kp) is a public health problem with important clinical and epidemiological implications. We describe an outbreak of KPC-Kp at vascular surgery and neurosurgery wards in a central hospital in Porto, Portugal.

Methods: A case of KPC-Kp was considered to be a patient positive for KPC-Kp with strong epidemiological plausibility of having acquired this microorganism in the affected wards and/or with genetic relationship ≥92% between KPC-Kp isolates. Active surveillance cultures (ASCs) and real-time polymerase chain reaction were used for the detection of carbapenemase genes through rectal swab in a selected population. Molecular analysis was performed using pulsed-field gel electrophoresis at the National Reference Laboratory. Patient risk factors were collected from the electronic medical record system. Information regarding outbreak containment strategy was collected from the Infection Control Unit records.

Results: Of the 16 cases, 11 (69%) were identified through active screening, representing 1.4% of the total 766 ASCs collected. The most frequent risk factors identified were previous admission (63%), antibiotic exposure in the past 6 months (50%), and immunodepression (44%). The length of stay until KPC-Kp detection was high (0-121 days, mean 35.6), as was the total length of stay (5-173 days, mean 56.6). Three patients (19%) were infected by KPC-Kp, 2 of whom died. One previously colonized patient died later because of KPC-Kp infection.

Conclusions: Multifactorial strategy based on contact precautions (with patient and healthcare professional cohorts) and ASC, as well as Antibiotic Stewardship Program reinforcement, allowed to contain this KPC-Kp outbreak.

Keywords: KPC-producing K pneumoniae; active surveillance cultures; antimicrobial resistance; carbapenemase-producing Enterobacteriaceae; contact precautions; outbreak.