Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics

Background. Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the blaOXA-232 gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancr...

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Bibliographic Details
Published in:Clinical infectious diseases 2017-10, Vol.65 (7), p.1159-1166
Main Authors: Humphries, Romney M., Yang, Shuan, Kim, Stephen, Muthusamy, Venkatara Raman, Russell, Dana, Trout, Alisa M., Zaroda, Teresa, Cheng, Quen J., Aldrovandi, Grace, Uslan, Daniel Zachary, Hemarajata, Peera, Rubin, Zachary Aaron
Format: Article
Language:English
Subjects:
Antibiotics
ARTICLES AND COMMENTARIES
Carbapenemase
Disease transmission
Disinfection
Drug resistance
Epidemics
Gene polymorphism
Gene sequencing
Genomes
Gram-negative bacteria
Health risks
Infections
Klebsiella
Klebsiella pneumoniae
Molecules
Nosocomial infections
Outbreaks
Patients
Polymerase chain reaction
Polymorphism
Reprocessing
Risk factors
Single-nucleotide polymorphism
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Summary:Background. Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the blaOXA-232 gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods. An outbreak investigation was performed when 9 patients with blaOXA-232 carbapenem-resistant K. pneumoniae infections were identified at a tertiary care hospital. The investigation included 2 case-control studies, review of duodenoscope reprocessing procedures, and culture of devices. Carbapenem-resistant Enterobacteriacieae (CRE) isolates were evaluated with polymerase chain reaction analysis for carbapenemase genes, and isolates with the blaOXA-232 gene were subjected to whole-genome sequencing and chromosome single-nucleotide polymorphism analysis. On recognition of ERCP as a key risk factor for infection, targeted patient notification and CRE screening cultures were performed. Results. Molecular testing ultimately identified 17 patients with blaOxa-232 carbapenem-resistant K. pneumoniae isolates, including 9 with infections, 7 asymptomatic carriers who had undergone ERCP, and 1 additonal patient who had been hospitalized in India and was probably the initial carrier. Two case-control studies established a point-source outbreak associated with 2 specific duodenoscopes. A field investigation of the use, reprocessing, and storage of deuodenoscopes did not identify deviations from US Food and Drug Administration or manufacturer recommendations for reprocessing. Conclusions. This outbreak demonstrated the previously underappreciated potential for duodenoscopes to transmit disease, even after undergoing high-level disinfection according to manufacturers' guidelines.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/cix527