Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Infect Control Hosp Epidemiol. 2010 May;31(5):476-84. doi: 10.1086/651670.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is resistant to almost all antimicrobial agents, and CRKP infections are associated with substantial morbidity and mortality.
To describe an outbreak of CRKP in Puerto Rico, determine risk factors for CRKP acquisition, and detail the successful measures taken to control the outbreak.
Two case-control studies.
A 328-bed tertiary care teaching hospital.
Twenty-six CRKP case patients identified during the outbreak period of February through September 2008, 26 randomly selected uninfected control patients, and 26 randomly selected control patients with carbapenem-susceptible K. pneumoniae (CSKP) hospitalized during the same period.
We performed active case finding, including retrospective review of the hospital's microbiology database and prospective perirectal surveillance culture sampling in high-risk units. Case patients were compared with each control group while controlling for time at risk. We sequenced the bla(KPC) gene with polymerase chain reaction for 7 outbreak isolates and subtyped these isolates with pulsed-field gel electrophoresis.
In matched, multivariable analysis, the presence of wounds (hazard ratio, 19.0 [95% confidence interval {CI}, 2.5-142.0]) was associated with CRKP compared with no K. pneumoniae. Transfer between units (adjusted odds ratio [OR], 7.5 [95% CI, 1.8-31.1]), surgery (adjusted OR, 4.0 [95% CI, 1.0-15.7]), and wounds (adjusted OR, 4.9 [95% CI, 1.1-21.8]) were independent risk factors for CRKP compared to CSKP. A novel K. pneumoniae carbapenemase variant (KPC-8) was present in 5 isolates. Implementation of active surveillance for CRKP colonization and cohorting of CRKP patients rapidly controlled the outbreak.
Enhanced surveillance for CRKP colonization and intensified infection control measures that include limiting the physical distribution of patients can reduce CRKP transmission during an outbreak.
耐碳青霉烯类肺炎克雷伯菌（CRKP）几乎对所有抗菌药物都具有耐药性，CRKP 感染与较高的发病率和死亡率相关。
描述波多黎各发生的耐碳青霉烯类肺炎克雷伯菌（CRKP）感染暴发，确定获得耐碳青霉烯类肺炎克雷伯菌的危险因素，并详细介绍成功采取的控制暴发的措施。
两项病例对照研究。
一家拥有 328 张病床的三级保健教学医院。
2008 年 2 月至 9 月暴发期间确定的 26 例耐碳青霉烯类肺炎克雷伯菌感染病例患者，同期随机选择的 26 例未感染对照患者，以及同期随机选择的 26 例患有碳青霉烯类敏感肺炎克雷伯菌（CSKP）的对照患者。
我们进行了主动病例发现，包括对医院微生物数据库的回顾性审查和高风险科室的直肠周围拭子前瞻性监测培养。将病例患者与每个对照组进行比较，同时控制风险时间。我们对 7 例暴发分离株进行 bla(KPC)基因的聚合酶链反应测序，并对这些分离株进行脉冲场凝胶电泳分型。
在匹配的多变量分析中，与无肺炎克雷伯菌相比，存在伤口（危险比，19.0[95%置信区间{CI}，2.5-142.0]）与耐碳青霉烯类肺炎克雷伯菌相关。与 CSKP 相比，科室间转科（校正比值比[OR]，7.5[95%CI，1.8-31.1]）、手术（校正 OR，4.0[95%CI，1.0-15.7]）和伤口（校正 OR，4.9[95%CI，1.1-21.8]）是耐碳青霉烯类肺炎克雷伯菌的独立危险因素。5 株分离株存在一种新型肺炎克雷伯菌碳青霉烯酶变体（KPC-8）。对耐碳青霉烯类肺炎克雷伯菌定植的主动监测以及对耐碳青霉烯类肺炎克雷伯菌患者的分组管理迅速控制了暴发。
加强对耐碳青霉烯类肺炎克雷伯菌定植的监测，并强化感染控制措施，包括限制患者的物理分布，可以减少暴发期间耐碳青霉烯类肺炎克雷伯菌的传播。
