What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing

BMJ Open

Volumn 5, Issue 5, 2015, Pages

  Haller, Sebastian ^a,b,c   Eller, Christoph ^c,d   Hermes, Julia ^c   Kaase, Martin ^e   Steglich, Matthias ^c   Radonić, Aleksandar ^c   Dabrowski, Piotr Wojtek ^c   Nitsche, Andreas ^c   Pfeifer, Yvonne ^c   Werner, Guido ^c   Wunderle, Werner ^f   Velasco, Edward ^c   Sin, Muna Abu ^c   Eckmanns, Tim ^c   Nübel, Ulrich ^c,g  

^a Postgraduate Training for Applied Epidemiology PAE   (Germany)

^b EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL ECDC   (Sweden)

^c ROBERT KOCH INSTITUTE   (Germany)

^d MARTIN LUTHER UNIVERSITÄT HALLE WITTENBERG   (Germany)

^e RUHR UNIVERSITY BOCHUM   (Germany)

^f Gesundheitsamt Bremen   (Germany)

^g LEIBNIZ INSTITUTE DSMZ GERMAN COLLECTION OF MICROORGANISMS AND CELL CULTURES   (Germany)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; BACTERIAL GENOME; BACTERIUM ISOLATE; CLINICAL ARTICLE; DISEASE TRANSMISSION; EXTENDED SPECTRUM BETA LACTAMASE PRODUCING KLEBSIELLA PNEUMONIAE; FEMALE; GENETIC DISTANCE; GERMANY; HOSPITAL INFECTION; HUMAN; KLEBSIELLA INFECTION; MALE; MOLECULAR EPIDEMIOLOGY; NEWBORN; NEWBORN INTENSIVE CARE; NONHUMAN; PHYLOGENY; RISK FACTOR; SEQUENCE ANALYSIS; SINGLE NUCLEOTIDE POLYMORPHISM; COHORT ANALYSIS; DNA SEQUENCE; ENDEMIC DISEASE; EPIDEMIC; EVOLUTION; GENETICS; KLEBSIELLA INFECTIONS; KLEBSIELLA PNEUMONIAE; METABOLISM; MICROBIOLOGY; NEONATAL INTENSIVE CARE UNIT; RETROSPECTIVE STUDY; TRANSMISSION;

BETA LACTAMASE;

BETA-LACTAMASES; BIOLOGICAL EVOLUTION; COHORT STUDIES; DISEASE OUTBREAKS; ENDEMIC DISEASES; FEMALE; GENOME, BACTERIAL; GERMANY; HUMANS; INFANT, NEWBORN; INTENSIVE CARE UNITS, NEONATAL; KLEBSIELLA INFECTIONS; KLEBSIELLA PNEUMONIAE; MALE; PHYLOGENY; RETROSPECTIVE STUDIES; SEQUENCE ANALYSIS, DNA;

EID: 84930226040     PISSN: None     EISSN: 20446055     Source Type: Journal    
DOI: 10.1136/bmjopen-2014-007397     Document Type: Article

References (25)

1. Tuffs A. Neonatal ward in Bremen is closed down again after two more deaths of babies. BMJ 2012; 344:e1680.
2. Tuffs A. Poor hospital hygiene is blamed for deaths of three babies in Bremen. BMJ 2011; 343:d7396.
3. Benenson S, Levin PD, Block C, et al. Continuous surveillance to reduce extended-spectrum beta-lactamase Klebsiella pneumoniae colonization in the neonatal intensive care unit. Neonatology 2013; 103: 155-60.
4. Harris AD, McGregor JC, Johnson JA, et al. Risk factors for colonization with extended-spectrum beta-lactamase-producing bacteria and intensive care unit admission. Emerg Infect Dis 2007; 13: 1144-9.
5. Sumer S, Turk Dagi H, Findik D, et al. Two outbreaks due to Esbl-producing Klebsiella pneumoniae in a neonatal intensive care unit. Pediatr Int 2014; 56: 222-6.
6. Selden R, Lee S, Wang WL, et al. Nosocomial klebsiella infections: intestinal colonization as a reservoir. Ann Intern Med 1971; 74: 657-64.
7. Gastmeier P, Vonberg RP. Klebsiella spp. in endoscopy-associated infections: we may only be seeing the tip of the iceberg. Infection 2014; 42: 15-21.
8. Jarvis WR, Munn VP, Highsmith AK, et al. The epidemiology of nosocomial infections caused by Klebsiella pneumoniae. Infect Control 1985; 6: 68-74.
9. Koser CU, Holden MT, Ellington MJ, et al. Rapid whole-genome sequencing for investigation of a neonatal MRSA outbreak. N Engl J Med 2012; 366: 2267-75.
10. Eyre DW, Cule ML, Wilson DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. N Engl J Med 2013; 369: 1195-205.
11. Nübel U, Nachtnebel M, Falkenhorst G, et al. MRSA transmission on a neonatal intensive care unit: epidemiological and genome-based phylogenetic analyses. PLoS ONE 2013; 8:e54898.
12. Snitkin ES, Zelazny AM, Thomas PJ, et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing. Sci Transl Med 2012; 4: 148ra16.
13. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995; 33: 2233-9.
14. Aziz RK, Bartels D, Best AA, et al. The RAST Server: rapid annotations using subsystems technology. BMC Genomics 2008; 9: 75.
15. Zhou Y, Liang Y, Lynch KH, et al. PHAST: a fast phage search tool. Nucleic Acids Res 2011; 39(Web Server issue):W347-52.
16. Fiett J, Palucha A, Miaczynska B, et al. A novel complex mutant beta-lactamase, TEM-68, identified in a Klebsiella pneumoniae isolate from an outbreak of extended-spectrum beta-lactamase-producing Klebsiellae. Antimicrob Agents Chemother 2000; 44: 1499-505.
17. Jombart T, Eggo RM, Dodd PJ, et al. Reconstructing disease outbreaks from genetic data: a graph approach. Heredity 2011; 106: 383-90.
18. He M, Miyajima F, Roberts P, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet 2013; 45: 109-13.
19. Roetzer A, Diel R, Kohl TA, et al. Whole genome sequencing versus traditional genotyping for investigation of a Mycobacterium tuberculosis outbreak: a longitudinal molecular epidemiological study. PLoS Med 2013; 10:e1001387.
20. Mutreja A, Kim DW, Thomson NR, et al. Evidence for several waves of global transmission in the seventh cholera pandemic. Nature 2011; 477: 462-5.
21. Harris SR, Feil EJ, Holden MT, et al. Evolution of MRSA during hospital transmission and intercontinental spread. Science 2010; 327: 469-74.
22. Nübel U, Dordel J, Kurt K, et al. A timescale for evolution, population expansion, and spatial spread of an emerging clone of methicillinresistant Staphylococcus aureus. PLoS Pathog 2010; 6:e1000855.
23. Clements A, Halton K, Graves N, et al. Overcrowding and understaffing in modern health-care systems: key determinants in methicillin-resistant Staphylococcus aureus transmission. Lancet Infect Dis 2008; 8: 427-34.
24. Robert Koch Institute. Mitteilung der Kommission für Krankenhaushygiene und Infektionsprävention: Ergänzende Empfehlung (2011) zur "Prävention nosokomialer Infektionen bei neonatologischen Intensivpflegepatienten mit einem Geburtsgewicht unter 1.500 g" (2007). Epidemiologisches Bull 2012; 2/2012: 13-15.
25. Christoph J, Dame C, Eckmanns T, et al. Praktische Umsetzung sowie krankenhaushygienische und infektionspräventive Konsequenzen des mikrobiellen Kolonisationsscreenings bei intensivmedizinisch behandelten Früh-und Neugeborenen. Epidemiologisches Bull 2013; 42/2013: 421-31.