An outpatient clinic as a potential site of transmission for an outbreak of NDM-producing Klebsiella pneumoniae ST716: a study using whole-genome sequencing.
(2019) Clinical infectious diseases — Vol. 68, n° 6, p. 993-1000 (2019)
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- (en) 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 Tn1331-like transposon, whereas none of the hospital B isolates did. The patient from hospital A who did not have the Tn1331-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.
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Heinrichs, A., Argudín, M. A., De Mendonça, R., Deplano, A., Roisin, S., Dodémont, M., Coussement, J., Filippin, L., Dombrecht, J., De Bruyne, K., Huang, T.-D., Supply, P., Byl, B., Glupczynski, G., & Denis, O. (2019). An outpatient clinic as a potential site of transmission for an outbreak of NDM-producing Klebsiella pneumoniae ST716: a study using whole-genome sequencing. Clinical infectious diseases, 68(6), 993-1000. https://doi.org/10.1093/cid/ciy581 (Original work published 2019)