Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital
ABSTRACT: Objectives: Infections by carbapenem-resistant Enterobacterales (CRE) in hospitals represent a severe threat but little is known on outbreaks in rehabilitation wards caused by Klebsiella pneumoniae producing Klebsiella pneumoniae Carbapenemase (KPC-Kp). We report an outbreak by KPC-Kp, in...
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Elsevier
2025-03-01
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| Series: | Journal of Global Antimicrobial Resistance |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2213716525000062 |
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| author | Maria Grazia Silvotti Erika Scaltriti Luca Bolzoni Beatrice Zerbi Gabriella Tocci Andrea Zappavigna Gianfranco Lamberti Federico Donati Franco Federici Stefano Pongolini Giuliana Lo Cascio |
| author_facet | Maria Grazia Silvotti Erika Scaltriti Luca Bolzoni Beatrice Zerbi Gabriella Tocci Andrea Zappavigna Gianfranco Lamberti Federico Donati Franco Federici Stefano Pongolini Giuliana Lo Cascio |
| author_sort | Maria Grazia Silvotti |
| collection | DOAJ |
| description | ABSTRACT: Objectives: Infections by carbapenem-resistant Enterobacterales (CRE) in hospitals represent a severe threat but little is known on outbreaks in rehabilitation wards caused by Klebsiella pneumoniae producing Klebsiella pneumoniae Carbapenemase (KPC-Kp). We report an outbreak by KPC-Kp, in a neurorehabilitation unit in Italy, analysed through whole-genome sequencing (WGS) for transmission routes reconstruction to improve management of KPC-Kp infections in rehabilitation units. Methods: We investigated cases and KPC-Kp isolates collected from February to October 2022 from hospital surveillance. Carbapenem resistance was identified with disk diffusion and minimum inhibitory concentration tests, carbapenemase production through immunochromatographic lateral flow assays. All isolates were genotyped through WGS to highlight possible phylogenetic relationships. The most likely transmission networks of KPC-Kp were reconstructed with Bayesian discrete-time stochastic models. Results: Nineteen patients were colonized by KPC-Kp. Two isolates belonged to sporadic sequence types (STs; ST348 and ST219) whereas 9 of 19 and 8 of 19 isolates belonged to ST307 and ST716, respectively. Among the ST307 isolates, we identified two genomically distinct clusters of five and two cases. All ST716 isolates were highly similar. Genotyping and the reconstruction of transmission networks of KPC-Kp based on genomic data identified seven independent introductions into the neurorehabilitation unit rather than a single outbreak as initially hypothesized before genomic investigation. Three of the seven introductions generated chains of secondary infections, whereas the remaining four remained single cases. Conclusions: The outbreak root-causes were identified in temporary staff shortage and insufficient microbiological surveillance. Measures were adopted accordingly and the outbreak ended. The study highlights the critical role of genomic epidemiology in hospital outbreaks. © 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. |
| format | Article |
| id | doaj-art-8738ebacd6394db4b5afd6cf1f0b4c4c |
| institution | Kabale University |
| issn | 2213-7165 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Journal of Global Antimicrobial Resistance |
| spelling | doaj-art-8738ebacd6394db4b5afd6cf1f0b4c4c2025-02-07T04:47:31ZengElsevierJournal of Global Antimicrobial Resistance2213-71652025-03-0141195201Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospitalMaria Grazia Silvotti0Erika Scaltriti1Luca Bolzoni2Beatrice Zerbi3Gabriella Tocci4Andrea Zappavigna5Gianfranco Lamberti6Federico Donati7Franco Federici8Stefano Pongolini9Giuliana Lo Cascio10Healthcare Facilities Hygiene Unit, Medical Direction Department, Piacenza General Hospital, Piacenza, ItalyRisk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, Parma, Italy; Corresponding author. Mailing address: Erika Scaltriti, Risk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, “Bruno Ubertini” Via dei Mercati 13/A, 43100, Parma, Italy.Risk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, Parma, ItalyHealthcare Facilities Hygiene Unit, Medical Direction Department, Piacenza General Hospital, Piacenza, Italy; Medicine and Surgery Department, University of Parma, Parma, ItalyMicrobiology Unit, Clinical Pathology Department, Piacenza General Hospital, Piacenza, ItalyMicrobiology Unit, Clinical Pathology Department, Piacenza General Hospital, Piacenza, ItalyNeurorehabilitation Unit, Rehabilitation Medicine Department, Piacenza General Hospital, Piacenza, ItalyNeurorehabilitation Unit, Rehabilitation Medicine Department, Piacenza General Hospital, Piacenza, ItalyHealthcare Facilities Hygiene Unit, Medical Direction Department, Piacenza General Hospital, Piacenza, ItalyRisk Analysis and Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia-Romagna, Parma, ItalyMicrobiology Unit, Clinical Pathology Department, Piacenza General Hospital, Piacenza, Italy; Medicine and Surgery Department, University of Parma, Parma, ItalyABSTRACT: Objectives: Infections by carbapenem-resistant Enterobacterales (CRE) in hospitals represent a severe threat but little is known on outbreaks in rehabilitation wards caused by Klebsiella pneumoniae producing Klebsiella pneumoniae Carbapenemase (KPC-Kp). We report an outbreak by KPC-Kp, in a neurorehabilitation unit in Italy, analysed through whole-genome sequencing (WGS) for transmission routes reconstruction to improve management of KPC-Kp infections in rehabilitation units. Methods: We investigated cases and KPC-Kp isolates collected from February to October 2022 from hospital surveillance. Carbapenem resistance was identified with disk diffusion and minimum inhibitory concentration tests, carbapenemase production through immunochromatographic lateral flow assays. All isolates were genotyped through WGS to highlight possible phylogenetic relationships. The most likely transmission networks of KPC-Kp were reconstructed with Bayesian discrete-time stochastic models. Results: Nineteen patients were colonized by KPC-Kp. Two isolates belonged to sporadic sequence types (STs; ST348 and ST219) whereas 9 of 19 and 8 of 19 isolates belonged to ST307 and ST716, respectively. Among the ST307 isolates, we identified two genomically distinct clusters of five and two cases. All ST716 isolates were highly similar. Genotyping and the reconstruction of transmission networks of KPC-Kp based on genomic data identified seven independent introductions into the neurorehabilitation unit rather than a single outbreak as initially hypothesized before genomic investigation. Three of the seven introductions generated chains of secondary infections, whereas the remaining four remained single cases. Conclusions: The outbreak root-causes were identified in temporary staff shortage and insufficient microbiological surveillance. Measures were adopted accordingly and the outbreak ended. The study highlights the critical role of genomic epidemiology in hospital outbreaks. © 2025 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.http://www.sciencedirect.com/science/article/pii/S2213716525000062Neurorehabilitation unitKPCKlebsiella pneumoniaeHospital outbreakST307ST716 |
| spellingShingle | Maria Grazia Silvotti Erika Scaltriti Luca Bolzoni Beatrice Zerbi Gabriella Tocci Andrea Zappavigna Gianfranco Lamberti Federico Donati Franco Federici Stefano Pongolini Giuliana Lo Cascio Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital Journal of Global Antimicrobial Resistance Neurorehabilitation unit KPC Klebsiella pneumoniae Hospital outbreak ST307 ST716 |
| title | Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital |
| title_full | Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital |
| title_fullStr | Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital |
| title_full_unstemmed | Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital |
| title_short | Outbreak of carbapenem resistant Klebsiella pneumoniae in a neurorehabilitation unit: Genomic epidemiology reveals complex transmission pattern in a tertiary care hospital |
| title_sort | outbreak of carbapenem resistant klebsiella pneumoniae in a neurorehabilitation unit genomic epidemiology reveals complex transmission pattern in a tertiary care hospital |
| topic | Neurorehabilitation unit KPC Klebsiella pneumoniae Hospital outbreak ST307 ST716 |
| url | http://www.sciencedirect.com/science/article/pii/S2213716525000062 |
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