Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics
Duodenoscope-Related Outbreak of a Carbapenem-Resistant Klebsiella pneumoniae Identified Using Advanced Molecular Diagnostics
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DOI：
10.1093/cid/cix527
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发表时间：
2017-10-01
影响因子：
11.8
通讯作者：
Rubin, Zachary Aaron
中科院分区：
文献类型：
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作者：
Humphries, Romney M.;Yang, Shuan;Rubin, Zachary Aaron
背景。耐碳青霉烯类肺炎克雷伯菌感染在北美医院中越来越普遍。我们描述了在内镜逆行胰胆管造影 (ERCP) 过程中通过污染的十二指肠镜传播的含有 bla(OXA-232) 基因的耐碳青霉烯类肺炎克雷伯菌的爆发。方法。当一家三级医院发现 9 名 bla(OXA-232) 碳青霉烯类耐药肺炎克雷伯菌感染患者时，进行了疫情调查。该调查包括两项病例对照研究、十二指肠镜再处理程序的审查以及设备培养。通过聚合酶链反应分析评估碳青霉烯类耐药肠杆菌（CRE）分离株的碳青霉烯酶基因，并对含有 bla（OXA-232）基因的分离株进行全基因组测序和染色体单核苷酸多态性分析。在认识到 ERCP 是感染的关键危险因素后，进行了有针对性的患者通知和 CRE 筛查培养。结果。分子检测最终确定了 17 名 bla(Oxa-232) 碳青霉烯类耐药肺炎克雷伯菌分离株患者，其中 9 名感染者、7 名接受过 ERCP 的无症状携带者，以及另外 1 名曾在印度住院且可能是最初携带者的患者。两项病例对照研究确定了与 2 个特定十二指肠镜相关的点源爆发。对十二指肠镜的使用、再处理和储存进行的现场调查没有发现与美国食品和药物管理局或制造商关于再处理建议的偏差。结论。此次疫情的爆发表明，即使十二指肠镜按照制造商指南进行了高水平消毒，其传播疾病的潜力仍被低估。
Background. Carbapenem-resistant Klebsiella pneumoniae infections are increasingly prevalent in North American hospitals. We describe an outbreak of carbapenem-resistant K. pneumoniae containing the bla(OXA-232) gene transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures.Methods. An outbreak investigation was performed when 9 patients with bla(OXA-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 bla(OXA-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.Results. Molecular testing ultimately identified 17 patients with bla(Oxa-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.Conclusions. This outbreak demonstrated the previously underappreciated potential for duodenoscopes to transmit disease, even after undergoing high-level disinfection according to manufacturers' guidelines.