Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan
Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan
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DOI：
10.1128/aac.01020-10
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发表时间：
2011-02-01
影响因子：
4.9
通讯作者：
Kaye, Keith S.
中科院分区：
文献类型：
--
作者：
Marchaim, Dror;Chopra, Teena;Kaye, Keith S.
耐碳青霉烯类肺炎克雷伯菌已在全球和美国各地传播。粘菌素广泛用于治疗这种微生物的感染。我们描述了涉及密歇根州底特律三个机构的一系列耐粘菌素、耐碳青霉烯类肺炎克雷伯菌感染病例。 2009 年 7 月 27 日至 8 月 22 日，底特律医疗中心 (DMC) 发现了 5 例耐粘菌素、耐碳青霉烯类肺炎克雷伯菌病例。收集了流行病学数据，并分析了传播机会。使用脉冲场凝胶电泳和重复外基因回文 PCR 对分离株进行基因分型。有关粘菌素使用的数据来自药房记录。 20 天后，在耐粘菌素、耐碳青霉烯类肺炎克雷伯菌指示病例之后，每隔 6 天又出现了 4 例病例。所有患者在某个时候都曾住在某一特定机构。患者之间传播机会的平均数为 2.3 +/- 0.5，每位患者至少有一次与其他患者传播的机会。与去年在 DMC 分离的 60 例粘菌素敏感、碳青霉烯类耐药肺炎克雷伯菌对照相比，病例患者年龄明显较大 (P = 0.05)，并且从他们身上分离出的碳青霉烯类耐药肺炎克雷伯菌对亚胺培南的 MIC 更高 (P < 0.001)。在疫情爆发前的几个月里，粘菌素的使用并未得到加强。基因分型揭示了两个密切相关的克隆。这份关于耐粘菌素、耐碳青霉烯类肺炎克雷伯菌爆发的报告与患者之间的传播密切相关。控制具有这种表型的细菌的传播和新出现至关重要。
Carbapenem-resistant Klebsiella pneumoniae has spread worldwide and throughout the United States. Colistin is used extensively to treat infections with this organism. We describe a cluster of colistin-resistant, carbapenem-resistant K. pneumoniae infection cases involving three institutions in Detroit, MI. A cluster of five cases of colistin-resistant, carbapenem-resistant K. pneumoniae was identified at Detroit Medical Center (DMC) from 27 July to 22 August 2009. Epidemiologic data were collected, and transmission opportunities were analyzed. Isolates were genotyped by using pulsed-field gel electrophoresis and repetitive extragenic palindromic PCR. Data regarding the use of colistin were obtained from pharmacy records. The index case of colistin-resistant, carbapenem-resistant K. pneumoniae was followed 20 days later by four additional cases occurring in a 6-day interval. All of the patients, at some point, had stayed at one particular institution. The mean number of opportunities for transmission between patients was 2.3 +/- 0.5, and each patient had at least one opportunity for transmission with one of the other patients. Compared to 60 colistin-susceptible, carbapenem-resistant K. pneumoniae controls isolated in the previous year at DMC, case patients were significantly older (P = 0.05) and the carbapenem-resistant K. pneumoniae organisms isolated from them displayed much higher MICs to imipenem (P < 0.001). Colistin use was not enhanced in the months preceding the outbreak. Genotyping revealed two closely related clones. This report of a colistin-resistant, carbapenem-resistant K. pneumoniae outbreak is strongly linked to patient-to-patient transmission. Controlling the spread and novel emergence of bacteria with this phenotype is of paramount importance.