K. pneumoniae on a MacConkey agar plate.
# 5717
For nearly two months a hospital in Rotterdam in the Netherlands has been battling an outbreak of CRKP - Carbapenem-Resistant Klebsiella pneumoniae – which may have been linked to as many as 27 deaths.
The exact cause of death has yet to be determined in all of these cases.
Klebsiella pneumoniae is a Gram negative, rod shaped bacterium commonly found in the flora of the human intestinal tract. Most of the time, it resides harmlessly in the intestines.
But when K. pneumoniae moves beyond the intestinal tract – particularly in people with weakened immune systems – it can cause cause severe pneumonia, urinary tract infections (UTI), septicemia, and soft tissue infections.
Complicating matters, over the past decade doctors have seen the emergence of antibiotic resistant forms of K. pneumoniae – known as CRKP or KPC (K. pneumoniae carbapenemase).
Bacteria resistant to the Carbapenem class of antibiotics – called carbapenemases – are of particular concern since Carbapenems are often used as the drug of last resort for treating difficult bacterial infections
K. Pneumoniae’s opportunistic qualities – attacking those with weakened immune systems - makes it an important, and difficult to control, hospital acquired (nosocomial) infection.
First a report from Xinhua News, and then I’ll return with more, including a press release from the hospital.
Multiple-resistant bacteria likely cause 27 deaths in Netherlands: hospital
2011-07-27 02:26:27
THE HAGUE, July 26 (Xinhua) -- Klebsiella bacterie Oxa-48, a kind of multi-resistant bacteria, may have caused 27 deaths in the Netherlands since June 1, a hospital source said Tuesday.
Though the 27 people died have all been infected with the bacteria, it didn't mean that all the deceased have died as a result of the bacteria, added the Maastad hospital in Rotterdam.
Research is under way to show the link between the deaths and the multiple resistant bacteria.
The hospital announced the first two death cases on June 1, while the latest report said 78 people are carrier of the bacteria and another 1,967 people are suspected carriers for the time being.
According to the following (machine translated) press release from the Maastad hospital, there have been no new infections detected since July 18th, and while more infections may be discovered, the situations is `under control’.
Press Release: Update multi-resistant bacteria in Rotterdam Hospital: July 26, 2011
On July 26, 2011, the Hospital Rotterdam the next situation that: 78 carriers of multiresistant bacteria, 27 in 1967 and deceased persons suspected patients.
Compared to July 21 this represents an increase of 8 carriers, two deceased persons and 143 suspected patients.
An increase of carriers automatically means more suspected patients, as they have been in the vicinity of the carriers. Given the current culture tests and examinations will increase the numbers in the near future.
At present, the Hospital Rotterdam, since July 18, no infections in patients receiving for the first time hospitalized. On this basis we can conclude that the outbreak is still under control.
This is the current state of affairs until July 26, 2011:
- The number of carriers of the bacteria increased from 70 to 78 patients
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- Of these 78 patients, a total of 27 deceased patients.
- It does not mean these 27 patients were deceased by the bacterium.
- Investigated the role of bacteria in the death of patients.
- -Of the 78 patients are currently only 8 patients in the hospital, which cared isolated.
- The number of people in a room located in the 78 carriers of the bacterium has increased from 1824 to 1967 people.
- The 143 additional people receive today a culture test by mail.
- At present there are 43 patients included isolated and tested.
- If it appears that more patients are infected, should be monitored in any patient with whom they have been in contact. This allows the number of infections is increasing.
While this is an unusually large nosocomial outbreak, it is by no means an isolated incident.
In 2010, a survey presented at the IDSA conference in Vancouver showed that Chicago was reporting a 42% rise in the number of hospitals and long-term care facilities reporting cases of KPC over last year.
Similarly, Brazil reported a substantial outbreak of KPC in 2010, which has been identified in more than 200 patients, and blamed for 22 deaths last year.
There have been outbreaks in many other countries, including Italy, Israel, France, Germany, the United Kingdom, Argentina, Lebanon, Israel, Morocco and Tunisia, and Ireland.
The gene that gives K. Pneumoniae its carbapenem resistance resides on a plasmid — a snippet of transferable DNA – that has the potential to jump to other strains of bacteria.
A trait that was recently demonstrated in an EID Journal dispatch (Transfer of Carbapenem-Resistant Plasmid from Klebsiella pneumoniae ST258 to Escherichia coli in Patient) in June, 2010.
One of the big concerns is that that we will see a transfer of carbapenem drug-resistance into a highly fit E. coli clone that could spread widely around the world.
From EID Journal Dispatch I referenced above, the authors write:
Such an event may have severe public health consequences, leading to elimination of any effective antimicrobial drug treatment against the most common human bacterial pathogens.
Ominous words.
Which is why such an emphasis is being placed on the proper stewardship over our dwindling arsenal of effective antibiotics.
Some recent blogs on this subject include:
Going, Going, Gonorrhea
The Path Of Increased Resistance
Carbapenemases Rising
WHO: The Threat Of Antimicrobial Resistance
Perhaps the single best place I can direct you to learn about the dangers and impact of antimicrobial resistance is our favorite `scary disease girl’ Maryn McKenna’s SUPERBUG BLOG and her terrific book on the subject SUPERBUG: The Fatal Menace Of MRSA.
