Department of Microbiology, Serres General Hospital, Serres, Greece.
J Clin Microbiol. 2012 Aug;50(8):2618-23. doi: 10.1128/JCM.00459-12. Epub 2012 May 30.
The recent emergence of carbapenemase-producing Enterobacteriaceae strains represents a major threat for hospitalized patients. We document the dissemination and control of carbapenemase-producing Klebsiella pneumoniae clones in a Greek hospital. During a 3-year study period (January 2009 to December 2011), carbapenemase-producing K. pneumoniae strains were isolated from clinical samples from 73 individual patients. Phenotyping and molecular testing confirmed that 52 patients were infected with K. pneumoniae carbapenemase 2 (KPC-2) producers, 12 were infected with VIM-1 producers, and the remaining 9 were infected with isolates producing both KPC-2 and VIM-1 enzymes. Twenty-eight of these clinical cases were characterized as imported health care associated, and 23 of these were attributed to KPC producers and 5 were attributed to KPC and VIM producers. The remaining 45 cases were deemed hospital acquired. In the second year of the study, intensified infection control intervention was implemented, followed by active surveillance and carrier isolation in the third year. The incidence of carbapenemase-producing K. pneumoniae patient cases decreased from 0.52/1,000 patient days in 2009 to 0.32/1,000 patient days in 2010 (P = 0.075). Following these additional infection control measures, the incidence fell to 0.21/1,000 patient days in 2011 and differed significantly from that in 2009 (P = 0.0028). Despite the fact that the imported cases of carbapenemase-producing K. pneumoniae were equally distributed over this 3-year period, the incidence of hospital-acquired cases decreased from 0.36/1,000 patient days in 2009 to 0.19/1,000 patient days in 2010 (P = 0.058) and to 0.1/1,000 patient days in 2011 (P = 0.0012). Our findings suggest that rigorous infection control measures and active surveillance can effectively reduce the incidence of secondary transmission due to KPC-producing pathogens.
最近，产碳青霉烯酶的肠杆菌科菌株的出现对住院患者构成了重大威胁。我们记录了希腊一家医院中产碳青霉烯酶肺炎克雷伯菌克隆的传播和控制情况。在 3 年的研究期间（2009 年 1 月至 2011 年 12 月），从 73 名个体患者的临床样本中分离出产碳青霉烯酶肺炎克雷伯菌菌株。表型和分子检测证实，52 名患者感染了产碳青霉烯酶 2（KPC-2）的肺炎克雷伯菌，12 名患者感染了产 VIM-1 的肺炎克雷伯菌，其余 9 名患者感染了同时产 KPC-2 和 VIM-1 酶的分离株。这些临床病例中有 28 例被确定为进口与医疗保健相关，其中 23 例归因于 KPC 生产者，5 例归因于 KPC 和 VIM 生产者。其余 45 例病例被认为是医院获得性的。在研究的第二年，实施了强化感染控制干预措施，然后在第三年进行了主动监测和携带者隔离。产碳青霉烯酶肺炎克雷伯菌患者病例的发生率从 2009 年的 0.52/1000 患者日下降到 2010 年的 0.32/1000 患者日（P = 0.075）。在采取了这些额外的感染控制措施后，2011 年的发病率下降至 0.21/1000 患者日，与 2009 年相比差异显著（P = 0.0028）。尽管在这 3 年期间，产碳青霉烯酶肺炎克雷伯菌的进口病例分布均匀，但医院获得性病例的发生率从 2009 年的 0.36/1000 患者日下降到 2010 年的 0.19/1000 患者日（P = 0.058）和 2011 年的 0.1/1000 患者日（P = 0.0012）。我们的研究结果表明，严格的感染控制措施和主动监测可以有效降低因产 KPC 病原体引起的二次传播的发生率。
