From July 2010-April 2013, Leipzig University Hospital experienced the largest outbreak of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae (KPC-2-Kp) strain observed in Germany to date. After termination of the outbreak, we aimed to reconstruct transmission pathways by phylogenetics based on whole-genome sequencing (WGS).One hundred seventeen KPC-2-Kp isolates from 89 outbreak patients, 5 environmental KPC-2-Kp isolates, and 24 K pneumoniae strains not linked to the outbreak underwent WGS. Phylogenetic analysis was performed blinded to clinical data and based on the genomic reads.A patient from Greece was confirmed as the source of the outbreak. Transmission pathways for 11 out of 89 patients (12.4%) were plausibly explained by descriptive epidemiology, applying strict definitions. Five of these and an additional 15 (ie, 20 out of 89 patients [22.5%]) were confirmed by phylogenetics. The rate of phylogenetically confirmed transmissions increased significantly from 8 out of 66 (12.1% for the time period before) to 12 out of 23 patients (52.2% for the time period after; P?<.001) after implementation of systematic screening for kpc-2-kp (33,623 investigations within 11 months). using descriptive epidemiology, showed no significant effect (7 out 66 [10.6%] vs 4 23 [17.4%] patients; p?=?.465). the phylogenetic analysis supported assumption that a contaminated positioning pillow served as reservoir persistence kpc-2-kp.effective identification transmissions requires microbiologic screening. extensive and based on wgs should be started soon possible in bacterial outbreak situation. copyright © 2018 association professionals infection control inc. published by elsevier all rights reserved.
Journal: American journal of infection control
DOI: 10.1016/j.ajic.2017.07.022
Year: 2018