Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital

• Published in: Infection control and hospital epidemiology Vol. 45; no. 3; pp. 292 - 301
• Main Authors: Rankin, Danielle A., Walters, Maroya Spalding, Caicedo, Luz, Gable, Paige, Moulton-Meissner, Heather A., Chan, Allison, Burks, Albert, Edwards, Kendra, McAllister, Gillian, Kent, Alyssa, Laufer Halpin, Alison, Moore, Christina, McLemore, Tracy, Thomas, Linda, Dotson, Nychie Q., Chu, Alvina K.
• Format: Journal Article
• Language: English
• Published: New York, USA Cambridge University Press 01.03.2024
• Subjects: Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacterial Proteins - genetics; beta-Lactamases - genetics; Catheters; Cohort analysis; Colonization; Comorbidity; Continuous positive airway pressure; Diabetes; Disease control; Environmental monitoring; Epidemics; Hemodialysis; Hospitals; Human subjects; Humans; Infections; Intensive care; Klebsiella pneumoniae; Length of stay; Medical equipment; Medical laboratories; Medical records; Microbial Sensitivity Tests; Original; Original Article; Ostomy; Outbreaks; Patients; Plasmids; Public health; Whole genome sequencing; Florida; United States > US
• ISSN: 0899-823X; 1559-6834; 1559-6834
• DOI: 10.1017/ice.2023.231

We investigated concurrent outbreaks of carrying (VIM-CRPA) and Enterobacterales carrying (KPC-CRE) at a long-term acute-care hospital (LTACH A). We defined an incident case as the first detection of or from a patient's clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had 11 had and 7 had and . Also, were identified from 7 Enterobacterales, and all were . We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.