Eurosurveillance - Volume 17, Issue 7, 16 February 2012

A rubella outbreak has been ongoing in Salaj, Romania since September 2011 involving 1,840 probable and confirmed cases among mainly unvaccinated adolescents. The index case had onset of illness on 6 September 2011. The highest number of cases was recorded among 10-14-year-olds and 15-19-year-olds. Complications were recorded for 11 cases and included meningitis and arthritis. Although the peak has passed, surveillance is being maintained in the region.

We report the identification of New Delhi metallo-beta-lactamase 1 (NDM-1)-producing Klebsiella pnemoniae in Ireland. The organism was resistant to multiple antibiotic classes, including carbapenems, and PCR and sequencing confirmed the presence of the blaNDM-1 gene, carried on a 98kb plasmid. The organism was isolated from an infant, who was born in India and moved to Ireland at the age of four months. This is the first reported isolation of an NDM-1-producing Enterobacteriaceae strain in Ireland.

We describe the isolation of an NDM-1-producing Acinetobacter baumannii in a Czech patient repatriated in July 2011 from Egypt. The infection spread to another patient on the same ward. Both isolates showed the same resistance pattern and were susceptible only to colistin. They had an identical PFGE pattern and belonged to the same sequence type ST 1. Sequencing of the blaNDM gene identified the NDM-1 variant of the carbapenemase, surrounded by two copies of insertion sequence ISAba125.

We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (p<0.0001). All genotyped KPC producers harboured blaKPC-2 and belonged to two clones, among which the hyperepidemic Greek clone, related to those from the United States and Israel, predominated. Most metallo-beta-lactamase (MBL) producers carried the blaVIM-1 gene and belonged to several clones, whereas all but one isolate with blaVIM-12 were clustered within a five-month period, arising from one clone. Resistance to non-beta-lactam antibiotics was also increased among CPKP. They were almost invariably resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Resistance to colistin increased from 3.5% (4/115) in 2008 to 20.8% (25/120) in 2010, and resistance to tigecycline also increased. Following reinforcement of infection control measures, prevalence of CPKP (mainly KPC) has been reduced since mid-2009 (from 46% in 2009 to 38.3% in 2010). In view of the exhaustion of available therapies, investment in infection control resources and optimal antibiotic use is urgently required.

This report describes the epidemiological features of the first outbreak caused by KPC3 carbapenemase-producing Klebsiella pneumoniae (KPC-3-KP) in Spain and how it was effectively controlled. From 16 September 2009 to the end of February 2010, seven patients infected or colonised with KPC-3-KP were detected. Stool surveillance cultures were recovered from patients, doctors, nurses, nursing assistants, cleaners and hospital porters working in the affected units. Hand swabs were taken from workers and patients' relatives for culturing. Environmental samples were also taken. Patients infected or colonised with KPC-3-KP were placed in single rooms under contact precautions and 4% chlorhexidine soap was used for their daily hygiene. Staff attended educational seminars and workshops on hand hygiene and isolation of patients. An alcohol-based disinfectant was used for surface cleaning and disinfecting. The floor was cleaned with a disinfectant containing benzalkonium chloride and didecyldimethylammonium. All samples collected were negative for KPC-3-KP. After implementing the control measures, no further cases were reported in the affected units. All cases had comorbidities, long hospital stay and aggressive/intensive antimicrobial treatment. This study emphasises the importance of early intensification of infection control to interrupt the transmission of KPC-producing organisms.

This report presents the main findings from an international workshop on Shiga toxin-producing Escherichia coli (STEC), held on 28-29 November 2011, organised by the Robert Koch Institute [1]. The workshop assembled over 100 experts in clinical medicine, epidemiology, public health, microbiology, food safety, and environmental science from various countries.