1. Outpatient Clinic as a Potential Site of Transmission for an Outbreak of New Delhi Metallo-β-Lactamase–producing Klebsiella pneumoniae Sequence Type 716: A Study Using Whole-genome Sequencing.
- Author
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Heinrichs, Amélie, Argudín, Maria Angeles, Mendonça, Ricardo De, Deplano, Ariane, Roisin, Sandrine, Dodémont, Magali, Coussement, Julien, Filippin, Lorenzo, Dombrecht, Jill, Bruyne, Katrien De, Huang, Te-Din, Glupczynski, Youri, Supply, Philip, Byl, Baudouin, and Denis, Olivier
- Subjects
PNEUMONIA diagnosis ,CROSS infection ,DNA ,DISEASE outbreaks ,MEDICAL care ,PHYLOGENY ,NOSOCOMIAL infections ,PNEUMONIA ,PULSED-field gel electrophoresis ,DISEASE incidence ,SEQUENCE analysis ,DIAGNOSIS ,INFECTIOUS disease transmission - Abstract
Background The incidence of nosocomial infections due to carbapenem-resistant Klebsiella pneumoniae is increasing worldwide. Whole-genome sequencing (WGS) can help elucidate the transmission route of nosocomial pathogens. Methods We combined WGS and epidemiological data to analyze an outbreak of New Delhi metallo-β-lactamase (NDM)–producing K. pneumoniae that occurred in 2 Belgian hospitals situated about 50 miles apart. We characterized 74 NDM-producing K. pneumoniae isolates (9 from hospital A, 24 from hospital B, and 41 contemporary isolates from 15 other Belgian hospitals) using pulsed-field gel electrophoresis and WGS. Results A K. pneumoniae sequence type 716 clone was identified as being responsible for the outbreak with all 9 strains from hospital A and 20 of 24 from hospital B sharing a unique pulsotype and being clustered together at WGS (compared with 1 of 41 isolates from other Belgian hospitals). We identified the outpatient clinic of hospital B as the probable bridging site between the hospitals after combining epidemiological, phylogenetic, and resistome data. We also identified the patient who probably caused the transmission. In fact, all but 1 strain from hospital A carried a Tn 1331-like transposon, whereas none of the hospital B isolates did. The patient from hospital A who did not have the Tn 1331-like transposon was treated at the outpatient clinic of hospital B on the same day as the first NDM-producing K. pneumoniae –positive patient from hospital B. Conclusions The results from our WGS-guided investigation highlight the importance of implementing adequate infection control measures in outpatient settings, especially when healthcare delivery moves from acute care facilities to outpatient clinics. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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