Program Schedule

Exposure Investigation and Infection Prevention Measures for a Patient with Confirmed NDM-1 Producing Klebsiella pneumoniae

Session: Poster Abstract Session: Multidrug-resistant Organisms: Epidemiology and Prevention
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • FINAL NDM-1 Poster for ID Week 2014.pdf (156.2 kB)
  • Background:

    Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi metallo-beta-lactamase-1 (NDM-1) enzyme is rarely seen in the United States. The first case of NDM-1 CRE at The Johns Hopkins Hospital (JHH) was identified in February 2014.


    When a patient's blood cultures grew NDM-1 Klebsiella pneumoniae on 2/18/2014, contact precautions and 1:1 nursing were initiated. Education was provided to staff to reinforce compliance with hand hygiene, isolation precautions, and environmental cleaning practices. All patient rooms on the involved units were disinfected using hydrogen-peroxide vapor.

    Medical records were reviewed and an exposure investigation was conducted.  Exposure criteria included any patient on the same unit as the source patient prior to the initiation of isolation precautions, or any patient occupying a room previously occupied by the source patient.

    Using a concentric circle approach, all inpatients meeting the exposure criteria were placed on contact precautions and rectal, urine, sputum, or wound surveillance cultures for CRE were collected per CDC recommendations. 


    The patient had prior travel history to India, but no healthcare exposure while there and no known history of multidrug-resistant organisms.  At JHH, the patient was on two surgical ICUs and one inpatient unit for a total of 27 days prior to the initiation of isolation precautions. 130 patients met criteria for potential exposure.  38 patients who were still inpatients had surveillance cultures obtained. One wound and two rectal cultures grew non-NDM-1 CRE (Figure).


    NDM-1 producing Klebsiella pneumoniae was detected in a patient with prior history of travel to, but no healthcare exposure in, India.  Despite 27 days of potential exposure prior to initiation of isolation precautions, no transmissions of NDM-1 CRE occurred, possibly due to excellent hand hygiene and environmental cleaning on the units to which the patient was admitted (Table).

    Table: Hand Hygiene and Environmental Cleaning Results during Potential NDM-1 CRE Exposure



    Hand Hygiene Compliance

    Environmental Cleaning Compliance

    January 2014

    February 2014

    January 2014

    February 2014

    ICU A





    ICU B










    Figure: Potentially Exposed Patients and Surveillance Culture Results


    Chelsea S. Lynch, RN, MSN, MPH1, Polly Trexler, MS, CIC2, Melanie S. Curless, RN, MPH2, Tsigereda Tekle, BS, MT(ASCP)3, Jamie Prestridge, MLS(ASCP)cm3, Meredith A. Black, MPH2, Julia Gardner, RN, CIC1, Melanie a. Gavin, M(ASCP), CIC4, Tracy a. Ross, MT(ASCP)4, Karen Carroll, MD5 and Lisa L. Maragakis, MD, MPH6, (1)Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, MD, (2)Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, MD, (3)The Johns Hopkins Hospital, Baltimore, MD, (4)Johns Hopkins Medical Institutions, Baltimore, MD, (5)John Hopkins University School of Medicine, Baltimore, MD, (6)The Johns Hopkins University School of Medicine, Baltimore, MD


    C. S. Lynch, None

    P. Trexler, None

    M. S. Curless, None

    T. Tekle, None

    J. Prestridge, None

    M. A. Black, None

    J. Gardner, None

    M. A. Gavin, None

    T. A. Ross, None

    K. Carroll, None

    L. L. Maragakis, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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