Advertisement

Outbreak of Klebsiella pneumoniae carbapenemase–producing K pneumoniae: A systematic review

      Background

      First detected in the United States in 1996, Klebsiella pneumoniae carbapenemase (KPC) has spread internationally among gram-negative bacteria, especially K pneumoniae. These microorganisms can cause serious infections in hospitalized patients, and there are few therapeutic options, culminating in increased mortality. The objective of this study was to describe the occurrence of outbreaks that were caused by KPC-producing K pneumoniae, emphasizing the interventions that were implemented to contain the outbreaks.

      Methods

      PubMed, Web of Knowledge, and Literatura Latino Americana em Ciências da Saúde databases were searched for articles that were published between 2001 and 2012 according to the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

      Results

      Of the 586 studies identified, 13 were selected for the final sample. Most studies showed that the containment of KPC outbreaks is possible in hospital settings through several actions, particularly use of surveillance cultures and the establishment of contact precautions.

      Conclusions

      The results show that limiting the cross-transmission of these and other KPC-producing bacteria is possible in a hospital setting. However, such isolates need to be detected early with the aid of culture surveillance and contained early using appropriate actions immediately to prevent an outbreak.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Yigit H.
        • Queenan A.M.
        • Anderson G.J.
        • Domenech-Sanchez A.
        • Biddle J.W.
        • Steward C.D.
        • et al.
        Novel carbapenem-hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae.
        Antimicrob Agents Chemother. 2001; 45: 1151-1161
        • Munoz-Price L.S.
        • Poirel L.
        • Bonomo R.A.
        • Schwaber M.J.
        • Daikos G.L.
        • Cormican M.
        • et al.
        Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases.
        Lancet Infect Dis. 2013; 13: 785-796
        • Nordmann P.
        • Naas T.
        • Poirel L.
        Global spread of carbapenemase-producing Enterobacteriaceae.
        Emerg Infect Dis. 2011; 17: 1791-1798
        • Pereira P.S.
        • de Araujo C.F.
        • Seki L.M.
        • Zahner V.
        • Carvalho-Assef A.P.
        • Asensi M.D.
        Update of the molecular epidemiology of KPC-2-producing Klebsiella pneumoniae in Brazil: spread of clonal complex 11 (ST11, ST437 and ST340).
        J Antimicrob Chemother. 2013; 68: 312-316
        • Gales A.C.
        • Castanheira M.
        • Jones R.N.
        • Sader H.S.
        Antimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010).
        Diagn Microbiol Infect Dis. 2012; 73: 354-360
        • Lee G.C.
        • Burgess D.S.
        Treatment of Klebsiella pneumoniae carbapenemase (KPC) infections: a review of published case series and case reports.
        Ann Clin Microbiol Antimicrob. 2012; 11: 32
        • Tumbarello M.
        • Viale P.
        • Viscoli C.
        • Trecarichi E.M.
        • Tumietto F.
        • Marchese A.
        • et al.
        Predictors of mortality in bloodstream infections caused by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae: importance of combination therapy.
        Clin Infect Dis. 2012; 55: 943-950
        • Zarkotou O.
        • Pournaras S.
        • Tselioti P.
        • Dragoumanos V.
        • Pitiriga V.
        • Ranellou K.
        • et al.
        Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment.
        Clin Microbiol Infect. 2011; 17: 1798-1803
        • Bogdanovich T.
        • Adams-Haduch J.M.
        • Tian G.B.
        • Nguyen M.H.
        • Kwak E.J.
        • Muto C.A.
        • et al.
        Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258.
        Clin Infect Dis. 2011; 53: 373-376
        • Tzouvelekis L.S.
        • Markogiannakis A.
        • Psichogiou M.
        • Tassios P.T.
        • Daikos G.L.
        Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions.
        Clin Microbiol Rev. 2012; 25: 682-707
        • Beller E.M.
        • Glasziou P.P.
        • Altman D.G.
        • Hopewell S.
        • Bastian H.
        • Chalmers I.
        • et al.
        PRISMA for Abstracts: reporting systematic reviews in journal and conference abstracts.
        PLoS Med. 2013; 10: e1001419
        • Souli M.
        • Galani I.
        • Antoniadou A.
        • Papadomichelakis E.
        • Poulakou G.
        • Panagea T.
        • et al.
        An outbreak of infection due to β-lactamase Klebsiella pneumoniae carbapenemase 2-producing K. pneumoniae in a Greek university hospital: molecular characterization, epidemiology, and outcomes.
        Clin Infect Dis. 2010; 50: 364-373
        • Agodi A.
        • Voulgari E.
        • Barchitta M.
        • Politi L.
        • Koumaki V.
        • Spanakis N.
        • et al.
        Containment of an outbreak of KPC-3-producing Klebsiella pneumoniae in Italy.
        J Clin Microbiol. 2011; 49: 3986-3989
        • Carbonne A.
        • Thiolet J.M.
        • Fournier S.
        • Fortineau N.
        • Kassis-Chikhani N.
        • Boytchev I.
        • et al.
        Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009.
        Euro Surveill. 2010; 15: 19734
        • Robustillo Rodela A.
        • Diaz-Agero Perez C.
        • Sanchez Sagrado T.
        • Ruiz-Garbajosa P.
        • Pita Lopez M.J.
        • Monge V.
        Emergence and outbreak of carbapenemase-producing KPC-3 Klebsiella pneumoniae in Spain, September 2009 to February 2010: control measures.
        Euro Surveill. 2012; 17: 20086
        • Endimiani A.
        • Depasquale J.M.
        • Forero S.
        • Perez F.
        • Hujer A.M.
        • Roberts-Pollack D.
        • et al.
        Emergence of blaKPC-containing Klebsiella pneumoniae in a long-term acute care hospital: a new challenge to our healthcare system.
        J Antimicrob Chemother. 2009; 64: 1102-1110
        • Wendt C.
        • Schutt S.
        • Dalpke A.H.
        • Konrad M.
        • Mieth M.
        • Trierweiler-Hauke B.
        • et al.
        First outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany.
        Eur J Clin Microbiol. 2010; 29: 563-570
        • Morris D.
        • Boyle F.
        • Morris C.
        • Condon I.
        • Delannoy-Vieillard A.S.
        • Power L.
        • et al.
        Inter-hospital outbreak of Klebsiella pneumoniae producing KPC-2 carbapenemase in Ireland.
        J Antimicrob Chemother. 2012; 67: 2367-2372
        • Gregory C.J.
        • Llata E.
        • Stine N.
        • Gould C.
        • Santiago L.M.
        • Vazquez G.J.
        • et al.
        Outbreak of carbapenem-resistant Klebsiella pneumoniae in Puerto Rico associated with a novel carbapenemase variant.
        Infect Control Hosp Epidemiol. 2010; 31: 476-484
        • Maltezou H.C.
        • Giakkoupi P.
        • Maragos A.
        • Bolikas M.
        • Raftopoulos V.
        • Papahatzaki H.
        • et al.
        Outbreak of infections due to KPC-2-producing Klebsiella pneumoniae in a hospital in Crete (Greece).
        J Infect. 2009; 58: 213-219
        • Ben-David D.
        • Maor Y.
        • Keller N.
        • Regev-Yochay G.
        • Tal I.
        • Shachar D.
        • et al.
        Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection.
        Infect Control Hosp Epidemiol. 2010; 31: 620-626
        • Munoz-Price L.S.
        • Hayden M.K.
        • Lolans K.
        • Won S.
        • Calvert K.
        • Lin M.
        • et al.
        Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae at a long-term acute care hospital.
        Infect Control Hosp Epidemiol. 2010; 31: 341-347
        • Munoz-Price L.S.
        • De La Cuesta C.
        • Adams S.
        • Wyckoff M.
        • Cleary T.
        • McCurdy S.P.
        • et al.
        Successful eradication of a monoclonal strain of Klebsiella pneumoniae during a K. pneumoniae carbapenemase-producing K. pneumoniae outbreak in a surgical intensive care unit in Miami, Florida.
        Infect Control Hosp Epidemiol. 2010; 31: 1074-1077
        • Snitkin E.S.
        • Zelazny A.M.
        • Thomas P.J.
        • Stock F.
        • Henderson D.K.
        • et al.
        • NISC Comparative Sequencing Program Group
        Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing.
        Sci Transl Med. 2012; 4: 148ra16
        • Schwaber M.J.
        • Lev B.
        • Israeli A.
        • Solter E.
        • Smollan G.
        • Rubinovitch B.
        • et al.
        Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention.
        Clin Infect Dis. 2011; 52: 848-855
        • Borer A.
        • Saidel-Odes L.
        • Riesenberg K.
        • Eskira S.
        • Peled N.
        • Nativ R.
        • et al.
        Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia.
        Infect Control Hosp Epidemiol. 2009; 30: 972-976
        • Mouloudi E.
        • Protonotariou E.
        • Zagorianou A.
        • Iosifidis E.
        • Karapanagiotou A.
        • Giasnetsova T.
        • et al.
        Bloodstream infections caused by metallo-beta-lactamase/Klebsiella pneumoniae carbapenemase-producing K. pneumoniae among intensive care unit patients in Greece: risk factors for infection and impact of type of resistance on outcomes.
        Infect Control Hosp Epidemiol. 2010; 31: 1250-1256
        • Centers for Disease Control and Prevention
        2012 CRE toolkit—guidance for control of carbapenem-resistant Enterobacteriaceae (CRE).
        (Available from:) (Accessed May 1, 2015)
        • Landman D.
        • Babu E.
        • Shah N.
        • Kelly P.
        • Olawole O.
        • Bäcker M.
        • et al.
        Transmission of carbapenem-resistant pathogens in New York City hospitals: progress and frustration.
        J Antimicrob Chemother. 2012; 67: 1427-1431
        • Schechner V.
        • Kotlovsky T.
        • Kazma M.
        • Mishali H.
        • Schwartz D.
        • Navon-Venezia S.
        • et al.
        Asymptomatic rectal carriage of blaKPC producing carbapenem-resistant Enterobacteriaceae: who is prone to become clinically infected.
        Clin Microbiol Infect. 2013; 19: 451-456
        • Navon-Venezia S.
        • Leavitt A.
        • Schwaber M.J.
        • Rasheed J.K.
        • Srinivasan A.
        • Patel J.B.
        • et al.
        First report on a hyperepidemic clone of KPC-3-producing Klebsiella pneumoniae in Israel genetically related to a strain causing outbreaks in the United States.
        Antimicrob Agents Chemother. 2009; 53: 818-820
        • Centers for Disease Control and Prevention
        Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities.
        MMWR Morb Mortal Wkly Rep. 2009; 58: 256-260
        • Borer A.
        • Eskira S.
        • Nativ R.
        • Saidel-Odes L.
        • Riesenberg K.
        • Livshiz-Riven I.
        • et al.
        A multifaceted intervention strategy for eradication of a hospital-wide outbreak caused by carbapenem-resistant Klebsiella pneumoniae in southern Israel.
        Infect Control Hosp Epidemiol. 2011; 32: 1158-1165
        • Gottesman T.
        • Agmon O.
        • Shwartz O.
        • Dan M.
        Household transmission of carbapenemase-producing Klebsiella pneumoniae.
        Emerg Infect Dis. 2008; 14: 859-860