Valsdottir F, Elfarsdottir Jelle A, Gudlaugsson O, Hilmarsdottir I
Department of Microbiology, Landspítali - The University Hospital of Iceland, Reykjavík, Iceland.
Department of Infection Control, Landspítali - The University Hospital of Iceland, Reykjavík, Iceland.
J Hosp Infect. 2017 Sep;97(1):42-51. doi: 10.1016/j.jhin.2017.04.002. Epub 2017 Apr 9.
Whereas Klebsiella species are the most frequently occurring agents in nosocomial outbreaks due to multidrug-resistant Gram-negative organisms, very few outbreaks have been reported from rehabilitation wards.
To describe a long-lasting outbreak due to extended-spectrum β-lactamase-producing (ESBL) Klebsiella pneumoniae in a rehabilitation ward.
ESBL K. pneumoniae from all in- and outpatients whose specimens were tested at a tertiary care university hospital between 2007 and 2012 were typed by pulsed-field gel electrophoresis and selected isolates were submitted to multi-locus sequence typing and ESBL genotyping. Outbreak characteristics and infection control interventions were summarized. The literature was searched for K. pneumoniae-related outbreaks in rehabilitation wards.
ESBL K. pneumoniae was detected in 69 out of 2478 K. pneumoniae-positive patients (2.8%) during the study period. Eight related outbreak clones from 35 patients, 25 of whom were in the rehabilitation ward, produced CTX-M-15 and belonged to ST336. The outbreak lasted for more than three years and was controlled by sequentially increasing measures culminating in review of all patient-related care, compulsory educational meetings for personnel, profession-specific guidelines and educational flyers for patients.
Half of ESBL K. pneumoniae-positive patients identified over six years at a tertiary care university hospital harboured related clones, and more than a third were hospitalized in a rehabilitation ward. Rehabilitation wards pose particular challenges for infection control because of patient dependency and an environment that encourages socializing. They are, however, rarely involved in K. pneumoniae-related outbreaks.
肺炎克雷伯菌是耐多药革兰氏阴性菌引起医院感染暴发中最常见的病原体，但康复病房报告的此类暴发却很少。
描述一家康复病房中由产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌引起的长期感染暴发。
对2007年至2012年间在一家三级护理大学医院进行标本检测的所有住院和门诊患者的ESBL肺炎克雷伯菌进行脉冲场凝胶电泳分型，选择分离株进行多位点序列分型和ESBL基因分型。总结暴发特征和感染控制干预措施。检索有关康复病房中肺炎克雷伯菌相关暴发的文献。
在研究期间，2478例肺炎克雷伯菌阳性患者中有69例（2.8%）检测到ESBL肺炎克雷伯菌。来自35例患者的8个相关暴发克隆，其中25例在康复病房，产生CTX-M-15，属于ST336。暴发持续了三年多，通过逐步加强措施得以控制，最终对所有与患者相关的护理进行审查，为工作人员举办强制性教育会议，制定针对特定专业的指南，并为患者发放教育传单。
在一家三级护理大学医院六年多时间里确诊的ESBL肺炎克雷伯菌阳性患者中，一半携带相关克隆，超过三分之一在康复病房住院。由于患者的依赖性以及鼓励社交的环境，康复病房在感染控制方面面临特殊挑战。然而，它们很少参与肺炎克雷伯菌相关的暴发。
