1. Transmission of Mobile Colistin Resistance (mcr-1) by Duodenoscope.
- Author
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Shenoy, Erica S, Pierce, Virginia M, Walters, Maroya Spalding, Moulton-Meissner, Heather, Lawsin, Adrian, Lonsway, David, Shugart, Alicia, McAllister, Gillian, Halpin, Alison Laufer, Zambrano-Gonzalez, Alejandra, Ryan, Erin E, Suslak, Dolores, DeJesus, Alexandra, Barton, Kerri, Madoff, Lawrence C, McHale, Eileen, DeMaria, Alfred, and Hooper, David C
- Subjects
COLISTIN ,ACADEMIC medical centers ,PREVENTION of communicable diseases ,CRITICAL care medicine ,DRUG resistance in microorganisms ,ESCHERICHIA coli ,GENES ,MICROBIAL sensitivity tests ,MEDICAL equipment safety measures ,GENOMICS ,MEDICAL equipment reliability ,ENDOSCOPIC gastrointestinal surgery ,KLEBSIELLA infections ,SEQUENCE analysis ,INFECTIOUS disease transmission ,THERAPEUTICS - Abstract
Background Clinicians increasingly utilize polymyxins for treatment of serious infections caused by multidrug-resistant gram-negative bacteria. Emergence of plasmid-mediated, mobile colistin resistance genes creates potential for rapid spread of polymyxin resistance. We investigated the possible transmission of Klebsiella pneumoniae carrying mcr -1 via duodenoscope and report the first documented healthcare transmission of mcr -1–harboring bacteria in the United States. Methods A field investigation, including screening targeted high-risk groups, evaluation of the duodenoscope, and genome sequencing of isolated organisms, was conducted. The study site included a tertiary care academic health center in Boston, Massachusetts, and extended to community locations in New England. Results Two patients had highly related mcr -1–positive K. pneumoniae isolated from clinical cultures; a duodenoscope was the only identified epidemiological link. Screening tests for mcr -1 in 20 healthcare contacts and 2 household contacts were negative. Klebsiella pneumoniae and Escherichia coli were recovered from the duodenoscope; neither carried mcr -1. Evaluation of the duodenoscope identified intrusion of biomaterial under the sealed distal cap; devices were recalled to repair this defect. Conclusions We identified transmission of mcr -1 in a United States acute care hospital that likely occurred via duodenoscope despite no identifiable breaches in reprocessing or infection control practices. Duodenoscope design flaws leading to transmission of multidrug-resistant organsisms persist despite recent initiatives to improve device safety. Reliable detection of colistin resistance is currently challenging for clinical laboratories, particularly given the absence of a US Food and Drug Administration–cleared test; improved clinical laboratory capacity for colistin susceptibility testing is needed to prevent the spread of mcr -carrying bacteria in healthcare settings. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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