Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida

Adriana Jiménez, José G. Castro, L. Silvia Munoz-Price, Dennise De Pascale, Luis Shimose, Mustapha M. Mustapha, Caressa N. Spychala, Roberta T. Mettus, Vaughn S. Cooper, Yohei Doi

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase-producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase-3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.

Original languageEnglish
Pages (from-to)320-326
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume38
Issue number3
DOIs
Publication statusPublished - 01-03-2017
Externally publishedYes

Fingerprint

Citrobacter freundii
Klebsiella pneumoniae
Tertiary Healthcare
Disease Outbreaks
Carbapenems
Genome
Microbial Sensitivity Tests
Infection Control
Tertiary Care Centers
Intensive Care Units
Clone Cells
carbapenemase
Infection

All Science Journal Classification (ASJC) codes

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Jiménez, Adriana ; Castro, José G. ; Munoz-Price, L. Silvia ; De Pascale, Dennise ; Shimose, Luis ; Mustapha, Mustapha M. ; Spychala, Caressa N. ; Mettus, Roberta T. ; Cooper, Vaughn S. ; Doi, Yohei. / Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida. In: Infection Control and Hospital Epidemiology. 2017 ; Vol. 38, No. 3. pp. 320-326.
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Jiménez, A, Castro, JG, Munoz-Price, LS, De Pascale, D, Shimose, L, Mustapha, MM, Spychala, CN, Mettus, RT, Cooper, VS & Doi, Y 2017, 'Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida', Infection Control and Hospital Epidemiology, vol. 38, no. 3, pp. 320-326. https://doi.org/10.1017/ice.2016.273

Outbreak of Klebsiella pneumoniae Carbapenemase-Producing Citrobacter freundii at a Tertiary Acute Care Facility in Miami, Florida. / Jiménez, Adriana; Castro, José G.; Munoz-Price, L. Silvia; De Pascale, Dennise; Shimose, Luis; Mustapha, Mustapha M.; Spychala, Caressa N.; Mettus, Roberta T.; Cooper, Vaughn S.; Doi, Yohei.

In: Infection Control and Hospital Epidemiology, Vol. 38, No. 3, 01.03.2017, p. 320-326.

Research output: Contribution to journalArticle

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AU - Jiménez, Adriana

AU - Castro, José G.

AU - Munoz-Price, L. Silvia

AU - De Pascale, Dennise

AU - Shimose, Luis

AU - Mustapha, Mustapha M.

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AU - Mettus, Roberta T.

AU - Cooper, Vaughn S.

AU - Doi, Yohei

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N2 - OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase-producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase-3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.

AB - OBJECTIVE To describe the investigation and control of a rare cluster of Klebsiella pneumoniae carbapenemase-producing Citrobacter freundii in a hospital in southern Florida. METHODS An epidemiologic investigation, review of infection prevention procedures, and molecular studies including whole genome sequencing were conducted. RESULTS An outbreak of K. pneumoniae carbapenemase-3-producing C. freundii was identified at a tertiary hospital in Florida in 2014. Of the 6 cases identified, 3 occurred in the same intensive care unit and were caused by the same clone. For 2 of the 3 remaining cases, the isolates had low carbapenem minimum inhibitory concentrations and were unrelated by whole genome sequencing. As a response to the outbreak, supplementary environmental cleaning was implemented, including closure and terminal cleaning of the unit where the 3 cases clustered, in addition to the infection control bundle already in place at the time. No further cases were identified after these additional interventions. CONCLUSIONS Although C. freundii is not a species that commonly demonstrates carbapenem resistance, our findings suggest that carbapenemase-producing C. freundii may be underdetected even when active surveillance is in place and has a potential to cause hospital outbreak.

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