Antimicrobial-Resistant Klebsiella pneumoniae Carriage and Infection in Specialized Geriatric Care Wards Linked to Acquisition in the Referring Hospital

July 15, 2018 at 5:01 pm

Clinical Infectious Diseases July 15, 2018 V.67 N.2 P.161-170

Claire L Gorrie; Mirjana Mirceta; Ryan R Wick; Louise M Judd; Kelly L Wyres …

La microbiota intestinal del paciente fue la fuente principal de Klebsiella pneumoniae, pero las cepas de β-lactamasa de espectro extendido (BLEE) se adquirieron en el hospital de referencia. Esto resalta el potencial para la detección ó screening rectal y la importancia de una red hospitalaria más amplia para el manejo local del riesgo.

Background

Klebsiella pneumoniae is a leading cause of extended-spectrum β-lactamase (ESBL)–producing hospital-associated infections, for which elderly patients are at increased risk.

Methods

We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing.

Results

K. pneumoniae throat carriage prevalence was 4.1%, rectal carriage 10.8%, and ESBL carriage 1.7%, and the incidence of K. pneumoniae infection was 1.2%. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried blaCTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase blaIMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a blaCTX-M-15 FIBK/FIIK plasmid in the referring hospital.

Conclusions

The data suggest the major source of K. pneumoniae was the patient’s own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities.

FULL TEXT

https://academic.oup.com/cid/article/67/2/161/4798841

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Entry filed under: Antimicrobianos, Bacterias, Epidemiología, Metodos diagnosticos, Prevencion y Control de Infecciones, REPORTS, Resistencia bacteriana, Update.

JULY 2018 – Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration? The Standardized Antimicrobial Administration Ratio: A New Metric for Measuring and Comparing Antibiotic Use


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