Klebsiella pneumoniae carbapenemase–producing K. pneumoniae represents a major public health issue. Infection is a recognized complication of endoscopic retrograde cholangiopancreatography (ERCP). Infections caused by these organisms have been associated with high mortality rates, which might be due in part to the limited availability of antibiotic options. Therefore, prevention of acquisition of these organisms is essential.
We conducted an epidemiologic and molecular investigation to identify the source of the outbreak involving patients undergoing ERCP. We carried out reviews of the medical and endoscopic charts and microbiological data. An intervention program including practice audits, surveillance cultures of duodenoscopes and environmental sites, and molecular typing of clinical and environmental isolates was implemented.
Between January and February 2015, 3 patients were identified with KPC–producing K pneumoniae related with ERCP, the first patient was the index case and presented the infection prior to the procedure; the other patients became infected after the procedure. The median age was 64 years; attack rate was 11.5% (3/26). There were 2 bloodstream infections and 3 intra-abdominal infections, 2 patients died. Clinical isolates were blaKPC gene carriers and were clonal (Figure 1). Routine surveillance cultures of endoscopes were repeatedly negative during the outbreak but the epidemic strain was finally isolated from one duodenoscope. The implementation of reprocessing equipment ERCP according to the recommendations of the CDC, staff education, elimination of reuse, and incorporating monitoring using bioluminescence and microbiological cultures allowed the control of the outbreak. For a year we have conducted weekly surveillance cultures of duodenoscopes and after each reprocessing surveillance with adenosine triphosphate (ATP) bioluminescence assays, if the result is greater than 100 relative light units (RLU)/s, the cleaning and disinfection procedure is repeated. There have not been new cases of infection since.
Control of an outbreak of KPC - K. pneumoniae related to ERCP can be successful through strict monitoring of cleaning and disinfection, education, and surveillance with cultures and bioluminescence.
Á. P. Gonzalez Rubio, None
S. Gualtero, None
G. C. Cortes Fraile, None
Y. Escobar, None
A. C. Hani Amador, None