351. First Report of Metallo-Beta-Lactamase Producing Enterobacteriaceae Outbreak Due to A Cold Tea Dispenser in Hospital
Session: Poster Abstract Session: HAI: Outbreaks
Thursday, October 8, 2015
Room: Poster Hall
  • IDWEEK2015 poster KI .pdf (1.3 MB)
  • Background: The spread of carbapenem-resistant enterobacteriaceae (CRE) is now recognized as an emerging global threat. Of the enterobacteriaceae found in Japan less than 1% contained metallo-beta-lactamase (MBL), mostly of the IMP-type. During an outbreak of MBL-producing enterobacteriaceae at a children’s hospital between May, 2014 and December, 2014, a rigorous investigation was undertaken to identify the causes.

    Methods: The index case was found incidentally from a clinical stool culture which grew MBL-producing Klebsiella pneumoniae. Because the isolated organism was an unusual, resistant strain, rectal swab screening was performed for the other patients in the ward, 6 of whom were later found to be positive for MBL-producing enterobacteriaceae. Once-weekly active surveillance by rectal swab was implemented and an environmental investigation was performed by internal and external teams. A retrospective cohort study was conducted to identify the factors associated with the transmission of MBL-producing enterobacteriaceae. Genotyping of isolates was performed by next generation sequencer.

    Results: Of the 249 patients admitted to the ward, 382 samples were obtained from 145 patients (58%) by means of active surveillance cultures. MBL-producing enterobacteriaceae were isolated from 36 patients (25%). None of them developed any clinical diseases. K. pneumoniae and Escherichia coli were predominant among the isolates. Environmental cultures also revealed MBL-producing K. pneumoniae in a sink, a formula-bottle cabinet, a cold tea dispenser, and the tea itself. All isolated organisms from the surveillance and environmental cultures possessed the blaIMP-1 gene. Drinking tea from the tea dispenser was associated with MBL-producing enterobacteriae colonization (adjusted odds ratio, 43.7; 95% confidence interval 7.3-260.5). After use of the tea dispenser was banned, the outbreak ceased.

    Conclusion: This is the first report of a contaminated tea dispenser in a hospital being associated with an MBL-producing eneterobacteriaceae outbreak. Awareness of the potential for transmission of MBL-producing enterobacteriaceae via such routes should be noted.

    Kenta Ito, MD1, Hitoshi Honda, MD, PhD2, Makiko Yoshida, PhD, MPH3, Koutaro Aoki, Bachelor of master degree4, Yoshikazu Ishii, Ph.D.4 and Yuho Horikoshi, MD5, (1)Infectious Disease, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan, (2)Division of Infectious Diseases, Department of Medicine, Tokyo Metropolitan Tama General Medical Center, Tokyo, Japan, (3)Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicin, Sendai, Japan, (4)Department of Microbiology and Infectious Diseases, Toho University School of Medicine, Tokyo, Japan, (5)Infectious Diseases, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan


    K. Ito, None

    H. Honda, None

    M. Yoshida, None

    K. Aoki, None

    Y. Ishii, None

    Y. Horikoshi, None

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