1402. Investigation of a Multiple Multidrug-Resistant Gram-Negative Bacilli Outbreak in a Canadian Hospital (or Help!! We Have CRE!!)
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • poster 1402 IDWeek2012 FINAL 15Oct2012.pdf (1.0 MB)
  • Background: New Delhi metallobetalactamase (NDM)- and OXA-48-producing Klebsiella pneumoniae and multidrug-resistant (MDR) Acinetobacter baumannii were identified in patients on multiple units in a Canadian tertiary care hospital.  The index patient had a recent hospital admission in the Indian subcontinent.  An investigation was initiated to (1) define the extent of transmission and (2) implement appropriate control measures. 

    Methods: An outbreak investigation was conducted on multiple patient care units in the 850-bed tertiary care hospital.  Patients colonized or infected with NDM- or OXA-48-producing K. pneumoniae, or MDR A. baumannii, from March to May 2012 were included.  Infection prevention and control [IPC] and environmental assessments, active surveillance cultures (ASC), pulsed-field gel electrophoresis [PFGE] for strain characterization, and polymerase chain reaction-based testing for carbapenemases were performed.  

    Results: In addition to the index case, NDM-producing K. pneumoniae and MDR A. baumannii were isolated from 2 patients each.  Two of the 3 K. pneumoniae isolates were identical by PFGE (1 was unrelated), while all 3 A. baumannii isolates were identical.  Only the index patient had an active infection; all other cases were identified by ASC.  IPC and environmental assessments determined that the index patient had been placed in a 4-bed room, although current protocols for patients with history of foreign hospitalization and patients with incontinence and/or copiously draining wounds recommend contact precautions in a private room.  In addition to ASC, IPC measures included institution of contact precautions, enhanced environmental cleaning and closure of multiple patient units.  In total, there were 370 contacts of varying risk and 43 total unit-closure days.             

    Conclusion: We hypothesize that the lack of both hand hygiene and appropriate use of personal protective equipment with ensuing environmental and medical equipment contamination contributed to transmission.  The complexities of laboratory testing for resistant Gram-negative bacilli and the enormous impact of the outbreak on hospital service delivery are highlighted.  This is one of the first reports of hospital transmission of NDM, and also one of the first reports of OXA-48 carbapenemase, in Canada.

    A. Uma Chandran, MD1,2, Amber-Leah Wolfe, BSc(MLS), CIC1, Sharla Manca, BSc (MLS), CIC1, Jasmine Ahmed-Bentley, MD2,3, Johann Pitout, MD4,5, Janet Barclay, BScN6 and A. Mark Joffe, MD1,2, (1)Infection Prevention and Control, Royal Alexandra Hospital, Edmonton, AB, Canada, (2)University of Alberta, Edmonton, AB, Canada, (3)DynaLIFEDx Diagnostic Laboratory Services, Edmonton, AB, Canada, (4)Calgary Laboratory Services, Calgary, AB, Canada, (5)Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada, (6)Infection Prevention and Control, Alberta Health Services - Edmonton Zone, Edmonton, AB, Canada

    Disclosures:

    A. U. Chandran, None

    A. L. Wolfe, None

    S. Manca, None

    J. Ahmed-Bentley, None

    J. Pitout, None

    J. Barclay, None

    A. M. Joffe, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 17th with the exception of research findings presented at the IDWeek press conferences.