1697. Prospective surveillance and rapid whole-genome sequencing detects two unsuspected outbreaks of carbapenemase-producing Klebsiella pneumoniae in a UK teaching hospital
Session: Oral Abstract Session: Resist! MDROs in Healthcare
Friday, October 6, 2017: 2:15 PM
Room: 01AB
Background:

The increasing incidence of carbapenemase-producing Enterobacteriaceae (CPE) is a global health concern, as treatment options are extremely limited. The prevalence of CPE in UK hospitals is unknown, as national screening guidelines only recommend screening in patients considered to be at high risk of CPE. Patients in intensive care units (ICU) are at high risk of healthcare-associated infections caused by multidrug-resistant organisms (MDRO).

Methods:

We conducted a six-month prospective surveillance study to determine the prevalence of MDRO in a UK teaching hospital ICU. Between June and December 2016, all adult patients admitted to ICU were screened for MDRO on admission, on discharge, and weekly during their ICU stay. Surveillance samples included stool or rectal swabs, urine, sputum or tracheal aspirates, and wound swabs (if wounds were present). Isolates were characterised phenotypically before undergoing whole-genome sequencing (WGS), epidemiological, and phylogenetic analyses.

Results:

During the first week of the study we identified stool carriage of a multidrug-resistant Klebsiella pneumoniae strain in two patients neither of whom had recognised risk factors for CPE. Both isolates were resistant to all antibiotics tested, apart from colistin, and were PCR-positive for the blaNDM-1 gene. Enhanced surveillance by the infection control team identified four additional patients in several wards who had stool carriage (n=3) or bloodstream infection (n=1) with a blaNDM-1 K. pneumoniae isolate. Epidemiological links were identified between these six patients.

Five months later, a second outbreak of multidrug-resistant K. pneumoniae was detected, involving stool carriage by four patients on two different wards. Environmental screening identified environmental contamination with multidrug-resistant K. pneumoniae on one ward. DNA sequence analysis confirmed that a novel blaNDM-1 K. pneumoniaelineage (ST78) was responsible for both outbreaks in the hospital.

Conclusion:

We identified two unsuspected blaNDM-1 K. pneumoniae outbreaks in patients with no recognised risk factors for CPE. This highlights the importance of prospective surveillance for MDRO in high-risk settings, such as ICUs, and supports the use of rapid WGS to support outbreak investigations in real time.

Estee Torok, MBBS PhD FRCP FRCPath1, Hayley Brodrick, PhD1, Fahad Khokhar, BSc1, Beth Blane, BSc1, Petra Polgarova, RN2, Joanne Brown, RN3, David Enoch, MBBS, FRCPath4, Nicholas Brown, MBBS FRCPath5, Charlotte Summers, BSc, BM, PhD, MRCP, FFICM1, Jacobus Preller, MBBS2, Nick Thomson, PhD6, Gordon Dougan, FMedSci, FRS6, Julian Parkhill, FMedSCi6 and Sharon Peacock, PhD FRCP FRCPath7, (1)Department of Medicine, University of Cambridge, Cambridge, United Kingdom, (2)John Farman Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom, (3)Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom, (4)Clinical Microbiology and Public Health Laboratory, Public Health England, Cambridge, United Kingdom, (5)Department of Microbiology, Public Health England, Cambridge, United Kingdom, (6)Wellcome Trust Sanger Institute, Cambridge, United Kingdom, (7)London School of Hygiene and Tropical Medicine, London, United Kingdom

Disclosures:

E. Torok, None

H. Brodrick, None

F. Khokhar, None

B. Blane, None

P. Polgarova, None

J. Brown, None

D. Enoch, None

N. Brown, None

C. Summers, None

J. Preller, None

N. Thomson, None

G. Dougan, None

J. Parkhill, None

S. Peacock, None

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