Dohle Christian, Korr Gerit, Friedrichs Michael, Kullmann Volker, Tung Mei-Lin, Kaase Martin, Rüssmann Holger, Sissolak Dagmar, Werber Dirk, Becker Laura, Fuchs Stephan, Pfeifer Yvonne, Semmler Torsten, Widders Gudrun, Eckmanns Tim, Werner Guido, Zill Edith, Haller Sebastian
MEDIAN Klinik Berlin-Kladow, Kladower Damm 223, 14089, Berlin, Deutschland.
Centrum für Schlaganfallforschung Berlin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2018 May;61(5):543-552. doi: 10.1007/s00103-018-2728-9.
In addition to acute care hospitals, rehabilitation centres are increasingly confronted with multi-resistant pathogens. Long durations of stay and intensive treatments impose special hygienic challenges.
We investigated an extended spectrum beta-lactamase-Klebsiella pneumoniae (ESBL-K. pneumoniae) outbreak in a neurorehabilitation centre. We defined confirmed cases as patients who stayed in the centre during the outbreak period and from whom ESBL-K. pneumoniae was isolated with the outbreak sequence type. Probable cases had an epidemiological link to at least one confirmed case but no isolate for typing. Next generation sequencing (NGS) was performed on 53 isolates from patients. Environmental sampling was performed. Systematic microbiological screening was implemented and ESBL-K. pneumoniae-positive patients were cohorted in a designated ward.
We identified 30 confirmed and 6 probable cases. NGS revealed three genetic clusters: Cluster 1 - the outbreak cluster - with isolates of 30 cases (sequence type ST15), Cluster 2 with 7 patients (ST405) and Cluster 3 with 8 patients (ST414). In two patients, the outbreak strain developed further antibiotic resistance, one with colistin resistance and the other carbapenem resistance. The outbreak ceased after strict isolation measures.
Epidemiology and NGS results paired with the effectiveness of cohorting suggest that transmission occurred mainly from person to person in this outbreak. There was an apparent association of the probability to acquire ESBL-K. pneumoniae and treatment intensity, whereas infection rate was related to morbidity. The identification of the outbreak clone and additional clusters plus the development of additional antibiotic resistance shows the relevance of NGS and highlights the need for timely and efficient outbreak management.
除急症医院外，康复中心也越来越多地面临多重耐药病原体的问题。长时间住院和强化治疗带来了特殊的卫生挑战。
我们调查了一家神经康复中心的产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-K. pneumoniae）暴发情况。我们将确诊病例定义为在暴发期间入住该中心且分离出具有暴发序列型的ESBL-K. pneumoniae的患者。可能病例与至少一例确诊病例有流行病学关联，但未分离出用于分型的菌株。对来自患者的53株分离株进行了下一代测序（NGS）。进行了环境采样。实施了系统的微生物筛查，并将ESBL-K. pneumoniae阳性患者集中安置在指定病房。
我们确定了30例确诊病例和6例可能病例。NGS显示三个基因簇：簇1 - 暴发簇 - 有30例病例的分离株（序列型ST15），簇2有7例患者（ST405），簇3有8例患者（ST414）。在两名患者中，暴发菌株产生了进一步的抗生素耐药性，一名对黏菌素耐药，另一名对碳青霉烯类耐药。采取严格隔离措施后暴发停止。
流行病学和NGS结果以及集中安置的有效性表明，此次暴发主要通过人传人发生。获得ESBL-K. pneumoniae的可能性与治疗强度明显相关，而感染率与发病率相关。暴发克隆和其他簇的鉴定以及额外抗生素耐药性的出现表明了NGS的相关性，并突出了及时有效进行暴发管理的必要性。
