Centre de coordination de la lutte contre les infections nosocomiales (CCLIN, Regional Coordinating Centre for Nosocomial Infection Control), Paris-Nord, France.
Euro Surveill. 2010 Dec 2;15(48):19734. doi: 10.2807/ese.15.48.19734-en.
An outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae type 2 was detected in September 2009 in two hospitals in a suburb south of Paris, France. In total, 13 KPC-producing K. pneumoniae type 2 cases (four with infections and nine with digestive-tract colonisations) were identified, including a source case transferred from a Greek hospital. Of the 13 cases, seven were secondary cases associated with use of a contaminated duodenoscope used to examine the source case (attack rate: 41%) and five were secondary cases associated with patient-to-patient transmission in hospital. All isolated strains from the 13 patients: (i) exhibited resistance to all antibiotics except gentamicin and colistin, (ii) were more resistant to ertapenem (minimum inhibitory concentration (MIC) always greater than 4 mg/L) than to imipenem (MIC: 1–8 mg/L, depending on the isolate), (iii) carried the blaKPC-2 and blaSHV12 genes and (iv) had an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern. These cases occurred in three hospitals: some were transferred to four other hospitals. Extended infection control measures implemented in the seven hospitals included: (i) limiting transfer of cases and contact patients to other wards, (ii) cohorting separately cases and contact patients, (iii) reinforcing hand hygiene and contact precautions and (iv) systematic screening of contact patients. Overall, 341 contact patients were screened. A year after the outbreak, no additional case has been identified in these seven hospitals. This outbreak emphasises the importance of rapid identification and notification of emerging highly resistant K. pneumoniae strains in order to implement reinforced control measures.
2009 年 9 月，法国巴黎南部郊区的两家医院发现了产碳青霉烯酶肺炎克雷伯菌（KPC）的肺炎克雷伯菌 2 型爆发。共发现 13 例产 KPC 的肺炎克雷伯菌 2 型病例（4 例感染，9 例消化道定植），包括从希腊一家医院转来的源病例。在 13 例病例中，有 7 例是与使用污染的十二指肠镜检查源病例（感染率：41%）相关的继发病例，5 例是与医院内患者之间传播相关的继发病例。从 13 位患者的所有分离株：（i）除庆大霉素和粘菌素外，对所有抗生素均表现出耐药性；（ii）对厄他培南的耐药性（最小抑菌浓度（MIC）始终大于 4mg/L）高于亚胺培南（MIC：1-8mg/L，取决于分离株）；（iii）携带 blaKPC-2 和 blaSHV12 基因；（iv）具有相同的脉冲场凝胶电泳（PFGE）模式。这些病例发生在 3 家医院：有些病例被转至其他 4 家医院。在 7 家医院实施的扩展感染控制措施包括：（i）限制病例和接触者向其他病房转移；（ii）分别将病例和接触者分组；（iii）加强手卫生和接触防护；（iv）对接触者进行系统筛查。共有 341 名接触者接受了筛查。疫情爆发一年后，这 7 家医院未发现新增病例。此次暴发强调了快速识别和通报新出现的高耐药肺炎克雷伯菌菌株的重要性，以便实施强化控制措施。
