Detection of NDM-7-Producing Escherichia coli by Surveillance Culture of Healthcare Workers in an Outbreak Setting. (4th October 2017)

• Record Type: Journal Article
• Authors: Kim, Kye-Hyung; Kim, So Ra; Kim, Hanwool; Hong, Seung Hyun; Kim, Hyewon; Jang, Mi Jin; Shin, Sunhea; Oh, Mi Young; Park, Nam Jeong; Lee, Jeong Eun; Kang, Jin Suk; Ko, Mee Kyung; Yi, Jongyoun
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S173
• Page End: S173
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.312
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: In outbreak settings of carbapenemase-producing Enterobacteriaceae (CPE), screening of CPE-contacts is useful for identifying unrecognized CPE colonizers and transmission links. Although intestinal carriage of healthcare workers (HCWs) can promote transmission of CPE, data of healthcare worker (HCW) screening for CPE in outbreak settings are lacking. In September 2016, Escherichia coli with NDM-7 was isolated from two patients at a tertiary hospital in Korea. This outbreak was investigated. Methods: Carbapenem resistance was examined by disk diffusion and carbapenemase activity was screened by modified Hodge test (MHT). A real-time PCR assay was performed to detect five carbapenemase genes (NDM, KPC, VIM, IMP, OXA). Molecular subtyping of bla NDM was performed by conventional PCR and direct sequencing. The genetic backgrounds of E. coli isolates were determined by multilocus sequence typing (MLST). Epidemiological investigations of CPE contacts including HCWs were done. Surveillance cultures of rectal swabs were performed by CDC methods. Results: Patient 1 was admitted to an intensive care unit (ICU) due to soft-tissue infection of legs. At admission, no organisms were isolated from the legs. The status of wound worsened and carbapenem-resistant E. coli was isolated. The isolate was MHT-positive and typed as NDM-7. Patient 2 was admitted to the same ICU due to respiratory failure, and carbapenem-resistant E. coli with NDM-7 was isolated from urine culture. Upon recognition of the outbreak, surveillance cultures of rectal swabs on 141 patient contacts including 114 HCWs were done. NDM-positive E. coli was isolated from one HCW. All three E. coli isolates belonged to ST167 by MLST. Three follow-up cultures of the HCW were negative. The surveillance cultures of four family members of the HCW were all negative. Conclusion: Epidemiologic investigation, combined with molecular methods, revealed the outbreak of NDM-7 E. coli . HCWs with epidemiologic links could be colonized by CPE, therefore, HCW screening might be needed in outbreak setting. Disclosures: All authors: No reported disclosures.