Posts filed under ‘Infecciones emergentes’

Control of a multi-hospital outbreak of KPC-producing Klebsiella pneumoniae type 2 in France, September to October 2009.

Euro Surveill. December 2, 2010 V.15 N.48. pii: 19734.

Carbonne A1, Thiolet JM, Fournier S, Fortineau N, Kassis-Chikhani N, Boytchev I, Aggoune M, Seguier JC, Senechal H, Tavolacci MP, Coignard B, Astagneau P, Jarlier V.


An outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae type 2 was detected in September 2009 in two hospitals in a suburb south of Paris, France. In total, 13 KPC-producing K. pneumoniae type 2 cases (four with infections and nine with digestive-tract colonisations) were identified, including a source case transferred from a Greek hospital. Of the 13 cases, seven were secondary cases associated with use of a contaminated duodenoscope used to examine the source case (attack rate: 41%) and five were secondary cases associated with patient-to-patient transmission in hospital. All isolated strains from the 13 patients: (i) exhibited resistance to all antibiotics except gentamicin and colistin, (ii) were more resistant to ertapenem (minimum inhibitory concentration (MIC) always greater than 4 mg/L) than to imipenem (MIC: 1–8 mg/L, depending on the isolate), (iii) carried the blaKPC-2 and blaSHV12 genes and (iv) had an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern. These cases occurred in three hospitals: some were transferred to four other hospitals. Extended infection control measures implemented in the seven hospitals included: (i) limiting transfer of cases and contact patients to other wards, (ii) cohorting separately cases and contact patients, (iii) reinforcing hand hygiene and contact precautions and (iv) systematic screening of contact patients. Overall, 341 contact patients were screened. A year after the outbreak, no additional case has been identified in these seven hospitals. This outbreak emphasises the importance of rapid identification and notification of emerging highly resistant K. pneumoniae strains in order to implement reinforced control measures



October 10, 2018 at 1:00 pm

Genomic Epidemiology of an Endoscope-Associated Outbreak of Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae.

PLoS One. December 4, 2015 V.10 N.12 P.e0144310.

Marsh JW1, Krauland MG1,2, Nelson JS1, Schlackman JL1, Brooks AM1, Pasculle AW3, Shutt KA1, Doi Y4, Querry AM5, Muto CA1,5, Harrison LH1.


Increased incidence of infections due to Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) was noted among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) at a single hospital. An epidemiologic investigation identified KPC-Kp and non-KPC-producing, extended-spectrum β-lactamase (ESBL)-producing Kp in cultures from 2 endoscopes. Genotyping was performed on patient and endoscope isolates to characterize the microbial genomics of the outbreak. Genetic similarity of 51 Kp isolates from 37 patients and 3 endoscopes was assessed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Five patient and 2 endoscope isolates underwent whole genome sequencing (WGS). Two KPC-encoding plasmids were characterized by single molecule, real-time sequencing. Plasmid diversity was assessed by endonuclease digestion. Genomic and epidemiologic data were used in conjunction to investigate the outbreak source. Two clusters of Kp patient isolates were genetically related to endoscope isolates by PFGE. A subset of patient isolates were collected post-ERCP, suggesting ERCP endoscopes as a possible source. A phylogeny of 7 Kp genomes from patient and endoscope isolates supported ERCP as a potential source of transmission. Differences in gene content defined 5 ST258 subclades and identified 2 of the subclades as outbreak-associated. A novel KPC-encoding plasmid, pKp28 helped define and track one endoscope-associated ST258 subclade. WGS demonstrated high genetic relatedness of patient and ERCP endoscope isolates suggesting ERCP-associated transmission of ST258 KPC-Kp. Gene and plasmid content discriminated the outbreak from endemic ST258 populations and assisted with the molecular epidemiologic investigation of an extended KPC-Kp outbreak.


October 10, 2018 at 12:57 pm

Ertapenem-Containing Double-Carbapenem Therapy for Treatment of Infections Caused by Carbapenem-Resistant Klebsiella pneumoniae.

Antimicrob Agents Chemother. 2015 Nov 9;60(1):669-73.

Cprek JB1, Gallagher JC2.

Author information

1 Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania, USA.

2 Department of Pharmacy Practice, Temple University, Philadelphia, Pennsylvania, USA


We describe outcomes of patients with infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) who received ertapenem-containing double-carbapenem therapy (ECDCT).

Clinical success was observed in 7/18 (39%) patients overall:

bloodstream infections, 3/7 (43%);

pneumonia, 1/5 (20%);

intraabdominal infections, 0/2 (0%);

urinary tract infections, 2/3 (67%); and a

skin and skin structure infection, 1/1 (100%).

Microbiologic success was observed in 11/14 (79%) evaluable patients; 5/18 (28%) patients died. ECDCT may be effective for CRKP infections with limited treatment options.


October 7, 2018 at 4:42 pm

Effectiveness of a double-carbapenem regimen for infections in humans due to carbapenemase-producing pandrug-resistant Klebsiella pneumoniae.

Antimicrobial Agents and Chemotherapy May 2013 V.57 N.5 P.2388-90.

Giamarellou H1, Galani L, Baziaka F, Karaiskos I.

Author information

1 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece.


Ertapenem plus doripenem or meropenem were given in three patients suffering from pandrug-resistant, KPC-2-positive Klebsiella pneumoniae bacteremia (2 patients) and urinary tract infection (1 patient), respectively.

All responded successfully, without relapse at follow-up. The results obtained should probably be attributed to ertapenem’s increased affinity for the carbapenemases hindering doripenem/meropenem degradation in the environment of the microorganism.


October 7, 2018 at 4:39 pm

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

Clinical Infectious Diseases October 1, 2017 V.65 N.7 P.1159-1166.     

Humphries RM1, Yang S1, Kim S2, Muthusamy VR2, Russell D3, Trout AM3, Zaroda T3, Cheng QJ4, Aldrovandi G5, Uslan DZ3, Hemarajata P1, Rubin ZA3.

1 Department of Pathology and Laboratory Medicine and.

2 Division of Digestive Diseases, David Geffen School of Medicine.

3 Clinical Epidemiology and Infection Prevention, and.

4 Division of Infectious Diseases, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, and.

5 Children’s Hospital of Los Angeles and Department of Pediatrics, Molecular Microbiology and Immunology, University of Southern California, Los Angeles.



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.


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.


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 additional 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.


This outbreak demonstrated the previously underappreciated potential for duodenoscopes to transmit disease, even after undergoing high-level disinfection according to manufacturers’ guidelines.



October 7, 2018 at 8:52 am

Guideline – Guidance document for prevention of C. difficile infection in acute healthcare settings

Clinical Microbiology and Infection October 2018 V.24 N.10 P.1051–1054

Tschudin-Sutter, E.J. Kuijper, A. Durovic, M.J.G.T. Vehreschild, F. Barbut, C. Eckert, F. Fitzpatrick, M. Hell, T. Norèn, J. O’Driscoll, J. Coia, P. Gastmeier, L. von Müller, M.H. Wilcox, A.F. Widmer on behalf of the Committee


Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes.


An expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings.

Questions addressed by the guideline and recommendations

This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.



September 29, 2018 at 10:34 am

Commentaries – Fluoroquinolones for urinary tract infection and within-household spread of resistant Enterobacteriaceae: the smoking gun

Clinical Microbiology and Infection september 2018 V.24 N.9  P.929–930

Barbara W. Trautner

The ‘smoking gun hypothesis’ refers to scientific evidence that strongly suggests—but falls just short of demonstrating—a causal relationship. The phrase originated in the 1983 Sherlock Holmes story The Adventure of the Gloria Scott in which the narrator rushes into a ship’s cabin to find a man shot on the floor and the chaplain holding a smoking pistol [1]. The paper in this issue of Clinical Microbiology and Infection by Stewardson et al. [2] presents smoking-gun evidence for the emergence of resistant strains of the Enterobacteriaceae after antibiotic treatment of urinary tract infections (UTIs), both in the treated individual and in the patient’s household contacts…




September 29, 2018 at 10:30 am

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