Josefine Haak, Ingo Klempien, Jörg B Hans, Stephan Schaefer, Kathrin Meyer-Bothling, Sören Gatermann, Esther E Dirks, Katharina Konrat, Mardjan Arvand
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引用次数: 0
Abstract
Objective: To report the epidemiologic, microbiologic and genetic investigation of a large outbreak of carbapenem-resistant Klebsiella pneumoniae associated with gastrointestinal endoscopy, including infection control interventions.
Methods: Internal and external audits of reprocessing procedure, systematic microbiological examination of reprocessed endoscopes, replacement of old endoscopes, investigation of channels of a dismantled endoscope, disinfectant efficacy testing on the outbreak strain´s biofilm, whole genome sequencing (WGS) analysis.
Results: In the early phase of outbreak, the outbreak strain was detected in 19 patients, 16 (84%) of whom had undergone GI endoscopy. The strain was also isolated from a reprocessed endoscope. WGS confirmed clonal relatedness of isolates and suggested transmission between patients via contaminated endoscopes. The reprocessing was audited, old endoscopes were replaced by new ones, and systematic microbiological examination of new endoscopes was introduced. In the follow-up, the outbreak strain was isolated from a new endoscope after reprocessing. Repeat audit revealed residual moisture in endoscope channels after reprocessing. Inspection of a dismantled endoscope revealed debris and scratches in channels. Disinfectant efficacy testing revealed tolerance of the outbreak strain´s biofilm to peracetic acid. Together, the outbreak strain was isolated from 32 patients and two reprocessed endoscopes. WGS suggested patient-to-patient as route of transmission in the outbreak's later phase.
Conclusions: A multi-stage strategy was required to contain this outbreak. Microscopic analysis showed evidence of biofilm formation in endoscope channels and the outbreak strain´s biofilm showed tolerance to the disinfectant used for reprocessing. Our data underscores the need for continued vigilance in infection control practices and reprocessing protocols for endoscopes.
期刊介绍：
The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience.
The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that:
provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings;
provide new insight into cleaning, disinfection and decontamination;
provide new insight into the design of healthcare premises;
describe novel aspects of outbreaks of infection;
throw light on techniques for effective antimicrobial stewardship;
describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control;
improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change;
improve understanding of the use of IT systems in infection surveillance and prevention and control.
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