Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit
Objective: Multi-drug-resistant bacteria burden is rising in both developing and high-income countries. We describe here a cluster of colistin and carbapenem-resistant K. pneumoniae, (CCRKP) in an educational and training hospital in Turkey, mainly associated with intensive care unit (ICU) stays. M...
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Galenos Publishing House
2025-04-01
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| Series: | Cam & Sakura Medical Journal |
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| Online Access: | https://csmedj.org/articles/successful-control-of-a-colistin-and-carbapenem-resistant-lessemgreaterklebsiella-pneumoniaelessemgreater-outbreak-in-an-intensive-care-unit/doi/csmedj.galenos.2025.2025-3-1 |
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| author | Ahsen Öncül Aziz Ahmad Hamidi Dilek Yıldız Sevgi İlkay Ordu Balık Zuhal Kalaycı Çekin Mehmet Emin Bulut Barış Otlu Elif Aktaş |
| author_facet | Ahsen Öncül Aziz Ahmad Hamidi Dilek Yıldız Sevgi İlkay Ordu Balık Zuhal Kalaycı Çekin Mehmet Emin Bulut Barış Otlu Elif Aktaş |
| author_sort | Ahsen Öncül |
| collection | DOAJ |
| description | Objective: Multi-drug-resistant bacteria burden is rising in both developing and high-income countries. We describe here a cluster of colistin and carbapenem-resistant K. pneumoniae, (CCRKP) in an educational and training hospital in Turkey, mainly associated with intensive care unit (ICU) stays.
Material and Methods: After CCRKP growth was detected in the microbiological samples of 21 patients who had a history of ICU hospitalization and were admitted to the hospital currently, the situation was classified as an epidemic. Rectal and environmental surveillance cultures were obtained. Carbapenemase production was tested by carbapenem inactivation method, and carbapenemase genes, including blaOXA-48, blaNDM-1, blaKPC, blaVIM, blaIMP and blaGES, were investigated by multiplex polymerase chain reaction (PCR). mcr1/2 genes associated with plasmid-mediated colistin resistance were investigated by PCR. CCRKP isolated from rectal and environmental screenings were evaluated further for epidemiologic relationships with clinical isolates. Pulsed-field gel electrophoresis was done using Xba-I enzyme for digestion.
Results: CCRKP rectal colonization prevalence was 57% (8/14) on the screening day. Five of these eight patients were colonized only, and none of these asymptomatic carriers developed infection. CCRKP was detected on an infusion pump, which was used for some of the previous patients and was suspected to be a cross contamination source. The outbreak isolate was found to be of genotype A; OXA-48 positive, NDM negative by PCR. mCR gene 1/2 was negative. One of the infected patients and one of the colonized patients isolates were different, and the remaining 22 isolates were indistinguishable. After strict infection control interventions, eight cases were detected in a five month period. Rectal swabbing was stopped after no new cases had been observed for two months. CCRKP hasn’t been detected in clinical specimens for one year since then.
Conclusion: Environmental screening and isolation of colonized patients have a crucial role in controlling outbreaks of multidrug-resistant Gram-negative bacteria. |
| format | Article |
| id | doaj-art-8de61b287d5f4d2098b89d4b96cea3a4 |
| institution | Kabale University |
| issn | 2791-8823 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Galenos Publishing House |
| record_format | Article |
| series | Cam & Sakura Medical Journal |
| spelling | doaj-art-8de61b287d5f4d2098b89d4b96cea3a42025-08-20T03:51:44ZengGalenos Publishing HouseCam & Sakura Medical Journal2791-88232025-04-0151313610.4274/csmedj.galenos.2025.2025-3-1Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care UnitAhsen Öncül0https://orcid.org/0000-0003-1612-7658Aziz Ahmad Hamidi1https://orcid.org/0000-0003-4108-0847Dilek Yıldız Sevgi2https://orcid.org/0000-0002-6047-4879İlkay Ordu Balık3https://orcid.org/0009-0008-2680-1152Zuhal Kalaycı Çekin4https://orcid.org/0000-0001-5293-2940Mehmet Emin Bulut5https://orcid.org/0000-0003-2097-3224Barış Otlu6https://orcid.org/0000-0002-6220-0521Elif Aktaş7https://orcid.org/0000-0003-3087-5425University of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Infectious Diseases and Clinical Microbiology, İstanbul, TurkeyUniversity of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Infectious Diseases and Clinical Microbiology, İstanbul, TurkeyUniversity of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Infectious Diseases and Clinical Microbiology, İstanbul, TurkeyUniversity of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Infection Control Committee, İstanbul, TurkeyUniversity of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Medical Microbiology, İstanbul, TurkeyUniversity of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Medical Microbiology, İstanbul, Turkeyİnönü University Faculty of Medicine, Department of Medical Microbiology, Malatya, TurkeyUniversity of Health Sciences Turkey, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Medical Microbiology, İstanbul, TurkeyObjective: Multi-drug-resistant bacteria burden is rising in both developing and high-income countries. We describe here a cluster of colistin and carbapenem-resistant K. pneumoniae, (CCRKP) in an educational and training hospital in Turkey, mainly associated with intensive care unit (ICU) stays. Material and Methods: After CCRKP growth was detected in the microbiological samples of 21 patients who had a history of ICU hospitalization and were admitted to the hospital currently, the situation was classified as an epidemic. Rectal and environmental surveillance cultures were obtained. Carbapenemase production was tested by carbapenem inactivation method, and carbapenemase genes, including blaOXA-48, blaNDM-1, blaKPC, blaVIM, blaIMP and blaGES, were investigated by multiplex polymerase chain reaction (PCR). mcr1/2 genes associated with plasmid-mediated colistin resistance were investigated by PCR. CCRKP isolated from rectal and environmental screenings were evaluated further for epidemiologic relationships with clinical isolates. Pulsed-field gel electrophoresis was done using Xba-I enzyme for digestion. Results: CCRKP rectal colonization prevalence was 57% (8/14) on the screening day. Five of these eight patients were colonized only, and none of these asymptomatic carriers developed infection. CCRKP was detected on an infusion pump, which was used for some of the previous patients and was suspected to be a cross contamination source. The outbreak isolate was found to be of genotype A; OXA-48 positive, NDM negative by PCR. mCR gene 1/2 was negative. One of the infected patients and one of the colonized patients isolates were different, and the remaining 22 isolates were indistinguishable. After strict infection control interventions, eight cases were detected in a five month period. Rectal swabbing was stopped after no new cases had been observed for two months. CCRKP hasn’t been detected in clinical specimens for one year since then. Conclusion: Environmental screening and isolation of colonized patients have a crucial role in controlling outbreaks of multidrug-resistant Gram-negative bacteria.https://csmedj.org/articles/successful-control-of-a-colistin-and-carbapenem-resistant-lessemgreaterklebsiella-pneumoniaelessemgreater-outbreak-in-an-intensive-care-unit/doi/csmedj.galenos.2025.2025-3-1carbapenem-resistant enterobacteriaceaeinfection controlklebsiella pneumoniaeoutbreak |
| spellingShingle | Ahsen Öncül Aziz Ahmad Hamidi Dilek Yıldız Sevgi İlkay Ordu Balık Zuhal Kalaycı Çekin Mehmet Emin Bulut Barış Otlu Elif Aktaş Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit Cam & Sakura Medical Journal carbapenem-resistant enterobacteriaceae infection control klebsiella pneumoniae outbreak |
| title | Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit |
| title_full | Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit |
| title_fullStr | Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit |
| title_full_unstemmed | Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit |
| title_short | Successful Control of a Colistin and Carbapenem Resistant Klebsiella pneumoniae Outbreak in an Intensive Care Unit |
| title_sort | successful control of a colistin and carbapenem resistant klebsiella pneumoniae outbreak in an intensive care unit |
| topic | carbapenem-resistant enterobacteriaceae infection control klebsiella pneumoniae outbreak |
| url | https://csmedj.org/articles/successful-control-of-a-colistin-and-carbapenem-resistant-lessemgreaterklebsiella-pneumoniaelessemgreater-outbreak-in-an-intensive-care-unit/doi/csmedj.galenos.2025.2025-3-1 |
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