Extended measures for controlling an outbreak of VIM-1 producing imipenem-resistant Klebsiella pneumoniae in a liver transplant centre in France, 2003–2004

N Kassis-Chikhani; F Saliba; A Carbonne; S Neuville; D Decre; C Sengelin; C Guerin; N Gastiaburu; A Lavigne-Kriaa; C Boutelier; G Arlet; D Samuel; D Castaing; E Dussaix; V Jarlier

doi:10.2807/ese.15.46.19713-en

Surveillance and outbreak reports Open Access

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Extended measures for controlling an outbreak of VIM-1 producing imipenem-resistant Klebsiella pneumoniae in a liver transplant centre in France, 2003–2004
N Kassis-Chikhani^1,2 , F Saliba³ , A Carbonne⁴ , S Neuville⁵ , D Decre^6,7,8 , C Sengelin^1,2 , C Guerin¹ , N Gastiaburu³ , A Lavigne-Kriaa³ , C Boutelier¹ , G Arlet^7,8,9 , D Samuel^3,10 , D Castaing^3,10 , E Dussaix^2,10 , V Jarlier^5,7,11
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Affiliations: ¹ Assistance Publique–Hôpitaux de Paris, hospital Paul Brousse, Infection Control Unit, Villejuif, France ² Assistance Publique–Hôpitaux de Paris, hospital Paul Brousse, Microbiology Laboratory, Villejuif, France ³ Assistance Publique–Hôpitaux de Paris, hospital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France ⁴ Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN, Coordinating centre in the fight against nosocomial infections) Paris-Nord, France ⁵ Assistance Publique–Hôpitaux de Paris, Central Infection Control Team, Paris, France ⁶ Assistance Publique–Hôpitaux de Paris, hospital Saint-Antoine, Bacteriology, Paris, France ⁷ Université Pierre et Marie Curie, Paris 6, France ⁸ ER8 Antibiotiques et Flore digestive, Université Paris 6, Paris, France ⁹ Assistance Publique–Hôpitaux de Paris, hospital Tenon, Bacteriology, Paris, France ¹⁰ Université Paris-Sud, UMR 785, Villejuif, France ¹¹ Assistance Publique–Hôpitaux de Paris, hospital Pitié-Salpétrière, Paris, France

Correspondence:
N Kassis-Chikhani
najiby.kassis-chikhani pbr.aphp.fr
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Citation style for this article: Kassis-Chikhani N, Saliba F, Carbonne A, Neuville S, Decre D, Sengelin C, Guerin C, Gastiaburu N, Lavigne-Kriaa A, Boutelier C, Arlet G, Samuel D, Castaing D, Dussaix E, Jarlier V. Extended measures for controlling an outbreak of VIM-1 producing imipenem-resistant Klebsiella pneumoniae in a liver transplant centre in France, 2003–2004. Euro Surveill. 2010;15(46):pii=19713. https://doi.org/10.2807/ese.15.46.19713-en Received: 16 Jun 2010

Abstract

We report the successful control of an outbreak caused by imipenem-resistant VIM-1-producing Klebsiella pneumoniae (IR-Kp) in France. This outbreak occurred in a care centre for abdominal surgery that includes a 15-bed liver intensive care unit and performs more than 130 liver transplantations per year. The index case was a patient with acute liver failure transferred from a hospital in Greece for urgent liver transplantation who was carrying IR-Kp at admission as revealed by routine culture of a rectal swab. Infection control measures were undertaken and included contact isolation and promotion of hand hygiene with alcohol-based hand rub solution. Nevertheless, secondary IR-Kp cases were identified during the six following months from 3 December 2003 to 2 June 2004. From 2 June to 21 October, extended infection control measures were set up, such as cohorting IR-Kp carriers, contact patients and new patients in distinct sections with dedicated staff, limiting ward admission, and strict control of patient transfer. They led to a rapid control of the outbreak. The global attack rate of the IR-Kp outbreak was 2.5%, 13% in liver transplant patients and 0.4% in the other patients in the care centre (p<0.005). Systematic screening for IR-Kp of all patients admitted to the care centre is still maintained to date and no secondary IR-Kp case has been detected since 2 June 2004.