Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan

Dror Marchaim, Teena Chopra, Jason M. Pogue, Federico Perez, Andrea M. Hujer, Susan Rudin, Andrea Endimiani, Shiri Navon-Venezia, Jatinder Hothi, Jessica Slim, Christopher Blunden, Maryann Shango, Paul R. Lephart, Hossein Salimnia, Deborah Reid, Judy Moshos, Wasif Hafeez, Suchitha Bheemreddy, Ting Yi Chen, Sorabh Dhar & 2 others Robert A. Bonomo, Keith S. Kaye

Research output: Contribution to journalArticle

140 Citations (Scopus)

Abstract

Carbapenem-resistant Klebsiella pneumoniae has spread worldwide and throughout the United States. Colistin is used extensively to treat infections with this organism. We describe a cluster of colistin-resistant, carbapenem-resistant K. pneumoniae infection cases involving three institutions in Detroit, MI. A cluster of five cases of colistin-resistant, carbapenem-resistant K. pneumoniae was identified at Detroit Medical Center (DMC) from 27 July to 22 August 2009. Epidemiologic data were collected, and transmission opportunities were analyzed. Isolates were genotyped by using pulsed-field gel electrophoresis and repetitive extragenic palindromic PCR. Data regarding the use of colistin were obtained from pharmacy records. The index case of colistin-resistant, carbapenem-resistant K. pneumoniae was followed 20 days later by four additional cases occurring in a 6-day interval. All of the patients, at some point, had stayed at one particular institution. The mean number of opportunities for transmission between patients was 2.3 ± 0.5, and each patient had at least one opportunity for transmission with one of the other patients. Compared to 60 colistin-susceptible, carbapenem-resistant K. pneumoniae controls isolated in the previous year at DMC, case patients were significantly older (P = 0.05) and the carbapenem-resistant K. pneumoniae organisms isolated from them displayed much higher MICs to imipenem (P < 0.001). Colistin use was not enhanced in the months preceding the outbreak. Genotyping revealed two closely related clones. This report of a colistin-resistant, carbapenem-resistant K. pneumoniae outbreak is strongly linked to patient-to-patient transmission. Controlling the spread and novel emergence of bacteria with this phenotype is of paramount importance.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
JournalAntimicrobial Agents and Chemotherapy
Volume55
Issue number2
DOIs
StatePublished - Feb 2011

Fingerprint

Colistin
Carbapenems
Klebsiella pneumoniae
Disease Outbreaks
Klebsiella Infections
Imipenem
Pulsed Field Gel Electrophoresis
Clone Cells
Bacteria
Phenotype
Polymerase Chain Reaction

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology
  • Infectious Diseases

Cite this

Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan. / Marchaim, Dror; Chopra, Teena; Pogue, Jason M.; Perez, Federico; Hujer, Andrea M.; Rudin, Susan; Endimiani, Andrea; Navon-Venezia, Shiri; Hothi, Jatinder; Slim, Jessica; Blunden, Christopher; Shango, Maryann; Lephart, Paul R.; Salimnia, Hossein; Reid, Deborah; Moshos, Judy; Hafeez, Wasif; Bheemreddy, Suchitha; Chen, Ting Yi; Dhar, Sorabh; Bonomo, Robert A.; Kaye, Keith S.

In: Antimicrobial Agents and Chemotherapy, Vol. 55, No. 2, 02.2011, p. 593-599.

Research output: Contribution to journalArticle

Marchaim, D, Chopra, T, Pogue, JM, Perez, F, Hujer, AM, Rudin, S, Endimiani, A, Navon-Venezia, S, Hothi, J, Slim, J, Blunden, C, Shango, M, Lephart, PR, Salimnia, H, Reid, D, Moshos, J, Hafeez, W, Bheemreddy, S, Chen, TY, Dhar, S, Bonomo, RA & Kaye, KS 2011, 'Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan', Antimicrobial Agents and Chemotherapy, vol. 55, no. 2, pp. 593-599. https://doi.org/10.1128/AAC.01020-10
Marchaim, Dror ; Chopra, Teena ; Pogue, Jason M. ; Perez, Federico ; Hujer, Andrea M. ; Rudin, Susan ; Endimiani, Andrea ; Navon-Venezia, Shiri ; Hothi, Jatinder ; Slim, Jessica ; Blunden, Christopher ; Shango, Maryann ; Lephart, Paul R. ; Salimnia, Hossein ; Reid, Deborah ; Moshos, Judy ; Hafeez, Wasif ; Bheemreddy, Suchitha ; Chen, Ting Yi ; Dhar, Sorabh ; Bonomo, Robert A. ; Kaye, Keith S. / Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan. In: Antimicrobial Agents and Chemotherapy. 2011 ; Vol. 55, No. 2. pp. 593-599.
@article{b0250a6375bd43d2860f8a835d34e70a,
title = "Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan",
abstract = "Carbapenem-resistant Klebsiella pneumoniae has spread worldwide and throughout the United States. Colistin is used extensively to treat infections with this organism. We describe a cluster of colistin-resistant, carbapenem-resistant K. pneumoniae infection cases involving three institutions in Detroit, MI. A cluster of five cases of colistin-resistant, carbapenem-resistant K. pneumoniae was identified at Detroit Medical Center (DMC) from 27 July to 22 August 2009. Epidemiologic data were collected, and transmission opportunities were analyzed. Isolates were genotyped by using pulsed-field gel electrophoresis and repetitive extragenic palindromic PCR. Data regarding the use of colistin were obtained from pharmacy records. The index case of colistin-resistant, carbapenem-resistant K. pneumoniae was followed 20 days later by four additional cases occurring in a 6-day interval. All of the patients, at some point, had stayed at one particular institution. The mean number of opportunities for transmission between patients was 2.3 ± 0.5, and each patient had at least one opportunity for transmission with one of the other patients. Compared to 60 colistin-susceptible, carbapenem-resistant K. pneumoniae controls isolated in the previous year at DMC, case patients were significantly older (P = 0.05) and the carbapenem-resistant K. pneumoniae organisms isolated from them displayed much higher MICs to imipenem (P < 0.001). Colistin use was not enhanced in the months preceding the outbreak. Genotyping revealed two closely related clones. This report of a colistin-resistant, carbapenem-resistant K. pneumoniae outbreak is strongly linked to patient-to-patient transmission. Controlling the spread and novel emergence of bacteria with this phenotype is of paramount importance.",
author = "Dror Marchaim and Teena Chopra and Pogue, {Jason M.} and Federico Perez and Hujer, {Andrea M.} and Susan Rudin and Andrea Endimiani and Shiri Navon-Venezia and Jatinder Hothi and Jessica Slim and Christopher Blunden and Maryann Shango and Lephart, {Paul R.} and Hossein Salimnia and Deborah Reid and Judy Moshos and Wasif Hafeez and Suchitha Bheemreddy and Chen, {Ting Yi} and Sorabh Dhar and Bonomo, {Robert A.} and Kaye, {Keith S.}",
year = "2011",
month = "2",
doi = "10.1128/AAC.01020-10",
language = "English (US)",
volume = "55",
pages = "593--599",
journal = "Antimicrobial Agents and Chemotherapy",
issn = "0066-4804",
publisher = "American Society for Microbiology",
number = "2",

}

TY - JOUR

T1 - Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan

AU - Marchaim, Dror

AU - Chopra, Teena

AU - Pogue, Jason M.

AU - Perez, Federico

AU - Hujer, Andrea M.

AU - Rudin, Susan

AU - Endimiani, Andrea

AU - Navon-Venezia, Shiri

AU - Hothi, Jatinder

AU - Slim, Jessica

AU - Blunden, Christopher

AU - Shango, Maryann

AU - Lephart, Paul R.

AU - Salimnia, Hossein

AU - Reid, Deborah

AU - Moshos, Judy

AU - Hafeez, Wasif

AU - Bheemreddy, Suchitha

AU - Chen, Ting Yi

AU - Dhar, Sorabh

AU - Bonomo, Robert A.

AU - Kaye, Keith S.

PY - 2011/2

Y1 - 2011/2

N2 - Carbapenem-resistant Klebsiella pneumoniae has spread worldwide and throughout the United States. Colistin is used extensively to treat infections with this organism. We describe a cluster of colistin-resistant, carbapenem-resistant K. pneumoniae infection cases involving three institutions in Detroit, MI. A cluster of five cases of colistin-resistant, carbapenem-resistant K. pneumoniae was identified at Detroit Medical Center (DMC) from 27 July to 22 August 2009. Epidemiologic data were collected, and transmission opportunities were analyzed. Isolates were genotyped by using pulsed-field gel electrophoresis and repetitive extragenic palindromic PCR. Data regarding the use of colistin were obtained from pharmacy records. The index case of colistin-resistant, carbapenem-resistant K. pneumoniae was followed 20 days later by four additional cases occurring in a 6-day interval. All of the patients, at some point, had stayed at one particular institution. The mean number of opportunities for transmission between patients was 2.3 ± 0.5, and each patient had at least one opportunity for transmission with one of the other patients. Compared to 60 colistin-susceptible, carbapenem-resistant K. pneumoniae controls isolated in the previous year at DMC, case patients were significantly older (P = 0.05) and the carbapenem-resistant K. pneumoniae organisms isolated from them displayed much higher MICs to imipenem (P < 0.001). Colistin use was not enhanced in the months preceding the outbreak. Genotyping revealed two closely related clones. This report of a colistin-resistant, carbapenem-resistant K. pneumoniae outbreak is strongly linked to patient-to-patient transmission. Controlling the spread and novel emergence of bacteria with this phenotype is of paramount importance.

AB - Carbapenem-resistant Klebsiella pneumoniae has spread worldwide and throughout the United States. Colistin is used extensively to treat infections with this organism. We describe a cluster of colistin-resistant, carbapenem-resistant K. pneumoniae infection cases involving three institutions in Detroit, MI. A cluster of five cases of colistin-resistant, carbapenem-resistant K. pneumoniae was identified at Detroit Medical Center (DMC) from 27 July to 22 August 2009. Epidemiologic data were collected, and transmission opportunities were analyzed. Isolates were genotyped by using pulsed-field gel electrophoresis and repetitive extragenic palindromic PCR. Data regarding the use of colistin were obtained from pharmacy records. The index case of colistin-resistant, carbapenem-resistant K. pneumoniae was followed 20 days later by four additional cases occurring in a 6-day interval. All of the patients, at some point, had stayed at one particular institution. The mean number of opportunities for transmission between patients was 2.3 ± 0.5, and each patient had at least one opportunity for transmission with one of the other patients. Compared to 60 colistin-susceptible, carbapenem-resistant K. pneumoniae controls isolated in the previous year at DMC, case patients were significantly older (P = 0.05) and the carbapenem-resistant K. pneumoniae organisms isolated from them displayed much higher MICs to imipenem (P < 0.001). Colistin use was not enhanced in the months preceding the outbreak. Genotyping revealed two closely related clones. This report of a colistin-resistant, carbapenem-resistant K. pneumoniae outbreak is strongly linked to patient-to-patient transmission. Controlling the spread and novel emergence of bacteria with this phenotype is of paramount importance.

UR - http://www.scopus.com/inward/record.url?scp=78751685746&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78751685746&partnerID=8YFLogxK

U2 - 10.1128/AAC.01020-10

DO - 10.1128/AAC.01020-10

M3 - Article

VL - 55

SP - 593

EP - 599

JO - Antimicrobial Agents and Chemotherapy

JF - Antimicrobial Agents and Chemotherapy

SN - 0066-4804

IS - 2

ER -