An Outpatient Clinic as a Potential Site of Transmission for an Outbreak of New Delhi Metallo-β-Lactamase–producing Klebsiella pneumoniae Sequence Type 716: A Study Using Whole-genome Sequencing. (18th July 2018)

• Record Type: Journal Article
• Authors: Heinrichs, Amélie; Argudín, Maria Angeles; De Mendonça, Ricardo; Deplano, Ariane; Roisin, Sandrine; Dodémont, Magali; Coussement, Julien; Filippin, Lorenzo; Dombrecht, Jill; De Bruyne, Katrien; Huang, Te-Din; Supply, Philip; Byl, Baudouin; Glupczynski, Youri; Denis, Olivier
• Is Part Of: Clinical infectious diseases. Volume 68:Number 6(2019)
• Page Start: 993
• Page End: 1000
• Publication Date: 2018-07-18
• Subjects: nosocomial outbreak -- carbapenemase -- infection control -- whole-genome MLST -- ambulatory care; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/ciy581
• Languages: English
• ISSNs: 1058-4838

Abstract

Abstract: Background: The incidence of nosocomial infections due to carbapenem-resistant Klebsiella pneumoniae is increasing worldwide. Whole-genome sequencing (WGS) can help elucidate the transmission route of nosocomial pathogens. Methods: We combined WGS and epidemiological data to analyze an outbreak of New Delhi metallo-β-lactamase (NDM)–producing K. pneumoniae that occurred in 2 Belgian hospitals situated about 50 miles apart. We characterized 74 NDM-producing K. pneumoniae isolates (9 from hospital A, 24 from hospital B, and 41 contemporary isolates from 15 other Belgian hospitals) using pulsed-field gel electrophoresis and WGS. Results: A K. pneumoniae sequence type 716 clone was identified as being responsible for the outbreak with all 9 strains from hospital A and 20 of 24 from hospital B sharing a unique pulsotype and being clustered together at WGS (compared with 1 of 41 isolates from other Belgian hospitals). We identified the outpatient clinic of hospital B as the probable bridging site between the hospitals after combining epidemiological, phylogenetic, and resistome data. We also identified the patient who probably caused the transmission. In fact, all but 1 strain from hospital A carried a Tn 1331-like transposon, whereas none of the hospital B isolates did. The patient from hospital A who did not have the Tn 1331-like transposon was treated at the outpatient clinic of hospital B on the same day as the first NDM-producing K. pneumoniae –positive patient from hospital B. Conclusions: The results from our WGS-guided investigation highlight the importance of implementing adequate infection control measures in outpatient settings, especially when healthcare delivery moves from acute care facilities to outpatient clinics. Abstract : Combining whole-genome sequencing data with epidemiological data, we investigated an outbreak of New Delhi metallo-β-lactamase–producing Klebsiella pneumoniae across 2 Belgian hospitals. We identified the outpatient clinic as the likely common site of transfer between the 2 institutions.