Extended measures for controlling an outbreak of VIM-1 producing imipenem-resistant Klebsiella pneumoniae in a liver transplant centre in France, 2003-2004

Euro Surveill. 2010 Nov 18;15(46):19713. doi: 10.2807/ese.15.46.19713-en.

Abstract

We report the successful control of an outbreak caused by imipenem-resistant VIM-1-producing Klebsiella pneumoniae (IR-Kp) in France. This outbreak occurred in a care centre for abdominal surgery that includes a 15-bed liver intensive care unit and performs more than 130 liver transplantations per year. The index case was a patient with acute liver failure transferred from a hospital in Greece for urgent liver transplantation who was carrying IR-Kp at admission as revealed by routine culture of a rectal swab. Infection control measures were undertaken and included contact isolation and promotion of hand hygiene with alcohol-based hand rub solution. Nevertheless, secondary IR-Kp cases were identified during the six following months from 3 December 2003 to 2 June 2004. From 2 June to 21 October, extended infection control measures were set up, such as cohorting IR-Kp carriers, contact patients and new patients in distinct sections with dedicated staff, limiting ward admission, and strict control of patient transfer. They led to a rapid control of the outbreak. The global attack rate of the IR-Kp outbreak was 2.5%, 13% in liver transplant patients and 0.4% in the other patients in the care centre (p<0.005). Systematic screening for IR-Kp of all patients admitted to the care centre is still maintained to date and no secondary IR-Kp case has been detected since 2 June 2004.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Cross Infection / epidemiology
  • Cross Infection / microbiology
  • Cross Infection / prevention & control*
  • Disease Outbreaks / prevention & control*
  • Drug Resistance, Bacterial
  • Female
  • France / epidemiology
  • Hospital Bed Capacity, 500 and over
  • Humans
  • Imipenem / pharmacology
  • Imipenem / therapeutic use
  • Infection Control / methods*
  • Intensive Care Units
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology
  • Klebsiella Infections / prevention & control
  • Klebsiella pneumoniae / classification
  • Klebsiella pneumoniae / enzymology
  • Klebsiella pneumoniae / isolation & purification*
  • Liver Transplantation
  • Male
  • Microbial Sensitivity Tests
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • Imipenem
  • VIM-1 metallo-beta-lactamase
  • beta-Lactamases