Antimicrobial Resistance and Microbial Ecology (ARME) Group, School of Medicine, National University of Ireland Galway, Galway, Ireland.
J Antimicrob Chemother. 2012 Oct;67(10):2367-72. doi: 10.1093/jac/dks239. Epub 2012 Jun 28.
To describe an outbreak of KPC-2-producing Klebsiella pneumoniae with inter-hospital spread and measures taken to control transmission.
Between January and March 2011, 13 K. pneumoniae isolates were collected from nine patients at hospital A and two patients at hospital B. Meropenem, imipenem and ertapenem MICs were determined by Etest, carbapenemase production was confirmed by the modified Hodge method and by a disc synergy test, and confirmed carbapenemase producers were tested for the presence of carbapenemase-encoding genes by PCR. PFGE, plasmid analysis, multilocus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST) analysis were performed on all or a subset of isolates.
Meropenem, imipenem and ertapenem MICs were 4 to >32, 8-32 and >16 mg/L, respectively. PCR and sequencing confirmed the presence of bla(KPC-2). PFGE identified four distinguishable (≥88%) pulsed-field profiles (PFPs). Isolates distinguishable by PFGE had identical MLVA profiles, and MLST analysis indicated all isolates belonged to the ST258 clone. Stringent infection prevention and control measures were implemented. Over a period of almost 8 months no further carbapenemase-producing Enterobacteriaceae (CPE) were isolated. However, KPC-2-producing K. pneumoniae was detected in two further patients in hospital A in August (PFP indistinguishable from previous isolates) and October 2011 (PFP similar to but distinguishable from previous isolates).
Stringent infection prevention and control measures help contain CPE in the healthcare setting; however, in the case of hospital A, where CPE appears to be established in the population served, it may be virtually impossible to achieve eradication or avoid reintroduction into the hospital.
描述产 KPC-2 肺炎克雷伯菌的暴发疫情，以及为控制传播而采取的措施。
2011 年 1 月至 3 月期间，从医院 A 的 9 名患者和医院 B 的 2 名患者中采集了 13 株肺炎克雷伯菌分离株。用 Etest 法测定美罗培南、亚胺培南和厄他培南 MIC，用改良 Hodge 法和纸片协同试验确认碳青霉烯酶的产生，并用 PCR 法检测产碳青霉烯酶的碳青霉烯酶编码基因。对所有或部分分离株进行 PFGE、质粒分析、多位点可变数串联重复分析（MLVA）和多位点序列分型（MLST）分析。
美罗培南、亚胺培南和厄他培南的 MIC 分别为 4 至＞32、8-32 和＞16mg/L。PCR 和测序证实 bla(KPC-2)的存在。PFGE 鉴定出 4 种可区分的（≥88%）脉冲场图谱（PFPs）。可通过 PFGE 区分的分离株具有相同的 MLVA 图谱，MLST 分析表明所有分离株均属于 ST258 克隆。实施了严格的感染预防和控制措施。在将近 8 个月的时间里，没有再分离出产碳青霉烯酶肠杆菌科（CPE）。然而，2011 年 8 月和 10 月，医院 A 又有 2 名患者检测出产 KPC-2 肺炎克雷伯菌（与之前的分离株不可区分的 PFPs）和产 KPC-2 肺炎克雷伯菌（与之前的分离株相似但可区分的 PFPs）。
严格的感染预防和控制措施有助于在医疗机构中控制 CPE；然而，在医院 A 中，CPE 似乎在其所服务的人群中已经建立，几乎不可能实现根除或避免重新引入医院。
