Successful control of a hospital-wide outbreak of OXA-48 producing Enterobacteriaceae in the Netherlands, 2009 to 2011

M J Dautzenberg; J M Ossewaarde; M E de Kraker; A van der Zee; S van Burgh; S C de Greeff; H A Bijlmer; H Grundmann; J W Cohen Stuart; A C Fluit; A Troelstra; M Bonten

doi:10.2807/1560-7917.ES2014.19.9.20723

Surveillance and outbreak reports Open Access

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Successful control of a hospital-wide outbreak of OXA-48 producing Enterobacteriaceae in the Netherlands, 2009 to 2011
M J Dautzenberg^1,2,3 , J M Ossewaarde¹ , M E de Kraker⁴ , A van der Zee¹ , S van Burgh¹ , S C de Greeff⁴ , H A Bijlmer⁴ , H Grundmann^4,5 , J W Cohen Stuart² , A C Fluit² , A Troelstra² , M Bonten^2,3
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Affiliations: ¹ Department of Medical Microbiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands ² Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands ³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands ⁴ Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands ⁵ University Medical Center Groningen, University of Groningen, the Netherlands

Correspondence:
M Dautzenberg
m.j.d.dautzenberg umcutrecht.nl
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Citation style for this article: Dautzenberg M J, Ossewaarde J M, de Kraker M E, van der Zee A, van Burgh S, de Greeff S C, Bijlmer H A, Grundmann H, Cohen Stuart J W, Fluit A C, Troelstra A, Bonten M. Successful control of a hospital-wide outbreak of OXA-48 producing Enterobacteriaceae in the Netherlands, 2009 to 2011. Euro Surveill. 2014;19(9):pii=20723. https://doi.org/10.2807/1560-7917.ES2014.19.9.20723 Received: 19 Sept 2013

Abstract

On 31 May 2011, after notification of Klebsiella pneumoniae (KP)_{OXA-48;CTX-M-15} in two patients, nosocomial transmission was suspected in a Dutch hospital. Hospital-wide infection control measures and an outbreak investigation were initiated. A total of 72,147 patients were categorised into groups based on risk of OXA-48 colonisation or infection, and 7,527 were screened for Enterobacteriaceae_OXA-48 by polymerase chain reaction (PCR). Stored KP isolates (n=408) were retrospectively tested for OXA-48 and CTX-M-1 group extended-spectrum beta-lactamases (ESBL). 285 KP isolates from retrospective and prospective patient screening were genotyped by amplified fragment length polymorphism (AFLP). 41 isolates harbouring different Enterobacteriaceae species were analysed by plasmid multilocus sequence typing (pMLST). No nosocomial transmission of Enterobacteriaceae_OXA-48 was detected after 18 July 2011. Enterobacteriaceae_OXA-48 were found in 118 patients (KP (n=99), Escherichia coli (n=56), ≥1 Enterobacteriaceae_OXA-48 species (n=52)), of whom 21 had clinical infections. 39/41 (95%) of OXA-48 containing plasmids were identical in pMLST. Minimum inhibitory concentrations (MICs) of KP_OXA-48 and E. coli_OXA-48 for imipenem and meropenem ranged from ≤1 to ≥16 mg/L, and 153/157 (97%) had MIC >0.25 mg/L for ertapenem. AFLP identified a cluster of 203 genetically linked isolates (62 KP_{OXA-48;CTX-M15}; 107 KP_CTX-M-15; 34 KP_OXA-48). The 'oldest' KP_CTX-M-15 and KP_OXA-48 clonal types originated from February 2009 and September 2010, respectively. The last presumed outbreak-related KP_OXA-48 was detected in April 2012. Uncontrolled transmission of KP_CTX-M-15 evolved into a nosocomial outbreak of KP_{OXA-48;CTX-M15} with large phenotypical heterogeneity. Although the outbreak was successfully controlled, the contribution of individual containment measures and of the hospital relocating into a new building just before outbreak notification was impossible to quantify. .