1395. Whole genome sequencing for investigation of a hospital outbreak of Klebsiella pneumoniae carbapenemase- (KPC-) producing Klebsiella pneumoniae (KPN) linked with an index case of community-acquired KPC-producing KPN infection
Session: Poster Abstract Session: HAI: Outbreaks
Friday, October 28, 2016
Room: Poster Hall

Background:

Emerging carbapenem-resistant enterobacteriacae makes it difficult to treat many gram-negative bacterial infection. We recently experienced a hospital outbreak of Klebsiella pneumoniae carbapenemase- (KPC-) producing Klebsiella pneumoniae (KPN) linked with an index case of community-acquired KPC-producing KPN infection. An outbreak investigation and whole genome sequencing analysis were performed to trace the outbreak and investigate the molecular characteristics of the isolates.

Methods:

Six cases of KPC-producing KPN were identified within the period October 2014 to February 2015. An epidemiological investigation and Pulsed field gel electrophoresis (PFGE) analysis showed 3 linked cases of which index case was community acquired. Active surveillance culture for exposed patients identified one more case with KPC-producing KPN colonization. Whole genome sequencing analysis for 4 linked cases were performed using a combination of Illumina Genome Analyzer (Illumina, San Diego, CA, USA) and Roche 454 (8-kb insert paired end) sequencing system.

Results:

The index case was an 74-year old man whom a KPN was cultured from a sample of sputum in September 2014 (Patient 1). Two patients (Patient 2, 3) shared same ward or Intensive care unit (ICU) with patient 1. Patient 1 was hospitalized with intracranial hemorrhage and KPC-producing KPN were cultured on the day of admission. Patient 1 had no history of health care use before the admission. PFGE was done and patient 1, 2, 3 were thought to have same clone. Active surveillance culture for exposed patients identified patient 7 with KPC-producing KPN.  Whole genome sequencing analysis showed the identical molecular structure of 4 linked isolates with KPC type 2 (Figure 1).

Conclusion:

We could investigate a hospital outbreak of KPC-producing KPN linked with an index case of community-acquired KPC-producing KPN infection with whole genome sequencing anlaysis.

Figure 1. Whole genomic sequencing analysis with 4 linked KPC-producing Klebsiella pneumoniae isolates from patient a)1, b)2, c)3 and d)7

Je Eun Song, MD1,2, Young Soun Lim, M.S3, Eunjin Ha, RN, MPH1, Hyunsoo Kim, MD4, Moo Hyun Kim, MD5,6, Woo Yong Jeong, MD5,6, In Young Jung, MD2,7, Dong Hyun Oh, MD7, Yong Chan Kim, MD2, Eun Jin Kim, MD5,7, Su Jin Jeong, MD/PhD2,3, Nam Su Ku, MD2,3, Eun Suk Park, RN, Ph.D.1, Dongeun Yong, MD, PhD8, Kyungwon Lee, MD, PhD9, June Myung Kim, MD, PhD2,3 and Jun Yong Choi, MD, PhD2, (1)Department of Infection Control, Yonsei University College of Medicine, Seoul, Korea, The Republic of, (2)Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea, (3)AIDS Research Institute, Yonsei University College of Medicine, Seoul, South Korea, (4)Department of Laboratory Medicine, Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea, The Republic of, (5)Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea, The Republic of, (6)AIDS Research Institue, Yonsei University of Medicine, Seoul, Korea, The Republic of, (7)AIDS Research Institute, Yonsei University college of Medicine, Seoul, Korea, The Republic of, (8)Laboratory Medicine, Yonsei University College of Medicine, Seoul, South Korea, (9)Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, South Korea

Disclosures:

J. E. Song, None

Y. S. Lim, None

E. Ha, None

H. Kim, None

M. H. Kim, None

W. Y. Jeong, None

I. Y. Jung, None

D. H. Oh, None

Y. C. Kim, None

E. J. Kim, None

S. J. Jeong, None

N. S. Ku, None

E. S. Park, None

D. Yong, None

K. Lee, None

J. M. Kim, None

J. Y. Choi, None

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