Foodborne Nosocomial Outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: Epidemiology and Control
Foodborne Nosocomial Outbreak of SHV1 and CTX-M-15-producing Klebsiella pneumoniae: Epidemiology and Control
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DOI：
10.1093/cid/ciq238
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发表时间：
2011-03-15
影响因子：
11.8
通讯作者：
Garau, Javier
中科院分区：
文献类型：
--
作者：
Calbo, Esther;Freixas, Nuria;Garau, Javier
背景。我们描述了一起由广谱β -内酰胺酶（ESBL）产生的肺炎克雷伯菌引起的食源性医院暴发。2008年3月发现了一次ESBL肺炎克雷伯菌暴发。最初的控制措施包括隔离接触者和制定常规检测和加强手部卫生习惯的规程。筛选ESBL产生者的bla（TEM）、bla（SHV）和bla（CTX-M）基因。用XbaI作为限制性内切酶进行脉冲场凝胶电泳分析。确定了156例定植和/或感染患者，其中35例（22.4%）感染。疫情影响了所有医院病房。部分病房患者粪便携带率高达38%。值得注意的是，调查显示在入学和殖民之间有很短的延迟。没有发现卫生保健工作者或病房内的环境表面被殖民化。这促使对可能的食源性传播进行流行病学调查。我们发现，高达35%的医院厨房屏蔽表面或食品被定植，44名食品处理人员中有6人（14%）被发现是粪便携带者。所有临床、环境和粪便携带者分离株的表型和基因型分析显示，传播了一株SHV-1和产生ctx - m -15的肺炎克雷伯菌。当时，厨房进行了结构和功能改革。随后住院患者的定植和感染率逐渐减少，直到2008年12月完全控制。不需要限制抗生素的使用。据我们所知，这是首次报告的医院疫情，为食物可能是ESBL肺炎克雷伯菌的传播媒介提供了证据。
Background. We describe a foodborne nosocomial outbreak due to extended-spectrum beta-lactamase (ESBL)producing Klebsiella pneumoniae.Methods. An outbreak of ESBL K. pneumoniae was detected in March 2008. Initial control measures included contact isolation and a protocol for routine detection and reinforcement in hand hygiene practices. ESBL producers were screened for the bla(TEM), bla(SHV), and bla(CTX-M) genes. Pulsed-field gel electrophoresis analysis was performed using XbaI as a restriction endonuclease.Results. One hundred fifty-six colonized and/or infected patients were identified, 35 (22.4%) of whom had infection. The outbreak affected all hospital wards. Fecal carriage was up to 38% of patients in some wards. Of note, investigation revealed a very short delay between admission and colonization. None of the health care workers or environmental surfaces in the wards was found to be colonized. This prompted an epidemiological investigation of a possible foodborne transmission. We found that up to 35% of the hospital kitchen-screened surfaces or foodstuff were colonized and that 6 (14%) of 44 food handlers were found to be fecal carriers. Phenotypic and genotypic analysis of all clinical, environmental, and fecal carrier isolates showed the dissemination of a single strain of SHV-1 and CTX-M-15-producing K. pneumoniae. At that time, structural and functional reforms in the kitchen were performed. These were followed by a progressive reduction in colonization and infection rates among inpatients until complete control was obtained in December 2008. No restrictions in the use of antibiotics were needed.Conclusions. To our knowledge, this is the first reported hospital outbreak that provides evidence that food can be a transmission vector for ESBL K. pneumoniae.