Characterization of an Outbreak of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit in Italy

Marta Corbella, Mariasofia Caltagirone, Stefano Gaiarsa, Bianca Mariani, Davide Sassera, Ibrahim Bitar, Alba Muzzi, Roberta Migliavacca, Luigia Scudeller, Mauro Stronati, Patrizia Cambieri

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Abstract

Here we report an outbreak of extended spectrum β-lactamase-producing Klebsiella pneumoniae that occurred in a neonatal intensive care unit in Northern Italy and involved 97 patients. Progressively tightened sets of containment measures were implemented but the epidemic event was stopped only 9 months later. The final, effective, containment strategy consisted of the application of strict geographic cohorting of colonized infants and their nursing staff, the suspension of any new admission and a rigorous daily sterilization protocol for all surfaces and fomites in the ward. A posteriori characterization of the outbreak strain was performed using both traditional microbiology and molecular biology techniques, and whole genome sequencing, allowing to compare outbreak isolates with other strains collected in the previous two years. The results allowed to determine that the outbreak strain had been circulating inside the ward since the year before. Genomic characterization revealed that the strain carried a wide array of virulence and antibiotic resistance determinants, including gene blaTEM-206, which had never been reported in a clinical isolate of K. pneumoniae before. The presence of such a high number of determinants for antibiotic resistance imposes significant therapeutic limitations on the treatment of infections, thus, further epidemiological investigations are needed to evaluate the prevalence of the newly described variant.

Original languageEnglish
Pages (from-to)1128-1136
Number of pages9
JournalMicrobial drug resistance (Larchmont, N.Y.)
Volume24
Issue number8
DOIs
Publication statusPublished - Oct 1 2018

Fingerprint

Neonatal Intensive Care Units
Klebsiella pneumoniae
Italy
Disease Outbreaks
Microbial Drug Resistance
Fomites
Nursing Staff
Microbiology
Virulence
Molecular Biology
Suspensions
Genome
Therapeutics
Infection
Genes

Keywords

  • ESBL
  • geographic cohorting
  • Klebsiella pneumoniae
  • neonatal intensive care unit
  • TEM-206

ASJC Scopus subject areas

  • Microbiology
  • Immunology
  • Pharmacology
  • Microbiology (medical)

Cite this

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title = "Characterization of an Outbreak of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit in Italy",
abstract = "Here we report an outbreak of extended spectrum β-lactamase-producing Klebsiella pneumoniae that occurred in a neonatal intensive care unit in Northern Italy and involved 97 patients. Progressively tightened sets of containment measures were implemented but the epidemic event was stopped only 9 months later. The final, effective, containment strategy consisted of the application of strict geographic cohorting of colonized infants and their nursing staff, the suspension of any new admission and a rigorous daily sterilization protocol for all surfaces and fomites in the ward. A posteriori characterization of the outbreak strain was performed using both traditional microbiology and molecular biology techniques, and whole genome sequencing, allowing to compare outbreak isolates with other strains collected in the previous two years. The results allowed to determine that the outbreak strain had been circulating inside the ward since the year before. Genomic characterization revealed that the strain carried a wide array of virulence and antibiotic resistance determinants, including gene blaTEM-206, which had never been reported in a clinical isolate of K. pneumoniae before. The presence of such a high number of determinants for antibiotic resistance imposes significant therapeutic limitations on the treatment of infections, thus, further epidemiological investigations are needed to evaluate the prevalence of the newly described variant.",
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T1 - Characterization of an Outbreak of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit in Italy

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AU - Caltagirone, Mariasofia

AU - Gaiarsa, Stefano

AU - Mariani, Bianca

AU - Sassera, Davide

AU - Bitar, Ibrahim

AU - Muzzi, Alba

AU - Migliavacca, Roberta

AU - Scudeller, Luigia

AU - Stronati, Mauro

AU - Cambieri, Patrizia

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