Antimicrobial-resistant klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

Claire L. Gorrie, Mirjana Mirceta, Ryan R. Wick, Louise M. Judd, Kelly L. Wyres, Nicholas R. Thomson, Richard A. Strugnell, Nigel F. Pratt, Jill S. Garlick, Kerrie M. Watson, Peter C. Hunter, Steve A. McGloughlin, Denis W. Spelman, Adam W.J. Jenney, Kathryn E. Holt

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background Klebsiella pneumoniae is a leading cause of extended-spectrum β-lactamase (ESBL)-producing hospital-associated infections, for which elderly patients are at increased risk. Methods We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing. Results K. pneumoniae throat carriage prevalence was 4.1%, rectal carriage 10.8%, and ESBL carriage 1.7%, and the incidence of K. pneumoniae infection was 1.2%. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried bla CTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase bla IMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a bla CTX-M-15 FIB K /FII K plasmid in the referring hospital. Conclusions The data suggest the major source of K. pneumoniae was the patient's own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities.

Original languageEnglish
Pages (from-to)161-170
Number of pages10
JournalClinical Infectious Diseases
Volume67
Issue number2
DOIs
Publication statusPublished - 2 Jul 2018
Externally publishedYes

Keywords

  • asymptomatic carriage
  • genomic epidemiology
  • geriatric care
  • Klebsiella pneumoniae
  • multidrug resistance

Cite this

Gorrie, Claire L. ; Mirceta, Mirjana ; Wick, Ryan R. ; Judd, Louise M. ; Wyres, Kelly L. ; Thomson, Nicholas R. ; Strugnell, Richard A. ; Pratt, Nigel F. ; Garlick, Jill S. ; Watson, Kerrie M. ; Hunter, Peter C. ; McGloughlin, Steve A. ; Spelman, Denis W. ; Jenney, Adam W.J. ; Holt, Kathryn E. / Antimicrobial-resistant klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital. In: Clinical Infectious Diseases. 2018 ; Vol. 67, No. 2. pp. 161-170.
@article{11dac6fb8cff4bb8bbdda4e09f60d710,
title = "Antimicrobial-resistant klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital",
abstract = "Background Klebsiella pneumoniae is a leading cause of extended-spectrum β-lactamase (ESBL)-producing hospital-associated infections, for which elderly patients are at increased risk. Methods We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing. Results K. pneumoniae throat carriage prevalence was 4.1{\%}, rectal carriage 10.8{\%}, and ESBL carriage 1.7{\%}, and the incidence of K. pneumoniae infection was 1.2{\%}. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried bla CTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase bla IMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a bla CTX-M-15 FIB K /FII K plasmid in the referring hospital. Conclusions The data suggest the major source of K. pneumoniae was the patient's own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities.",
keywords = "asymptomatic carriage, genomic epidemiology, geriatric care, Klebsiella pneumoniae, multidrug resistance",
author = "Gorrie, {Claire L.} and Mirjana Mirceta and Wick, {Ryan R.} and Judd, {Louise M.} and Wyres, {Kelly L.} and Thomson, {Nicholas R.} and Strugnell, {Richard A.} and Pratt, {Nigel F.} and Garlick, {Jill S.} and Watson, {Kerrie M.} and Hunter, {Peter C.} and McGloughlin, {Steve A.} and Spelman, {Denis W.} and Jenney, {Adam W.J.} and Holt, {Kathryn E.}",
year = "2018",
month = "7",
day = "2",
doi = "10.1093/cid/ciy027",
language = "English",
volume = "67",
pages = "161--170",
journal = "Clinical Infectious Diseases",
issn = "1058-4838",
publisher = "Oxford University Press",
number = "2",

}

Antimicrobial-resistant klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital. / Gorrie, Claire L.; Mirceta, Mirjana; Wick, Ryan R.; Judd, Louise M.; Wyres, Kelly L.; Thomson, Nicholas R.; Strugnell, Richard A.; Pratt, Nigel F.; Garlick, Jill S.; Watson, Kerrie M.; Hunter, Peter C.; McGloughlin, Steve A.; Spelman, Denis W.; Jenney, Adam W.J.; Holt, Kathryn E.

In: Clinical Infectious Diseases, Vol. 67, No. 2, 02.07.2018, p. 161-170.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Antimicrobial-resistant klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

AU - Gorrie, Claire L.

AU - Mirceta, Mirjana

AU - Wick, Ryan R.

AU - Judd, Louise M.

AU - Wyres, Kelly L.

AU - Thomson, Nicholas R.

AU - Strugnell, Richard A.

AU - Pratt, Nigel F.

AU - Garlick, Jill S.

AU - Watson, Kerrie M.

AU - Hunter, Peter C.

AU - McGloughlin, Steve A.

AU - Spelman, Denis W.

AU - Jenney, Adam W.J.

AU - Holt, Kathryn E.

PY - 2018/7/2

Y1 - 2018/7/2

N2 - Background Klebsiella pneumoniae is a leading cause of extended-spectrum β-lactamase (ESBL)-producing hospital-associated infections, for which elderly patients are at increased risk. Methods We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing. Results K. pneumoniae throat carriage prevalence was 4.1%, rectal carriage 10.8%, and ESBL carriage 1.7%, and the incidence of K. pneumoniae infection was 1.2%. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried bla CTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase bla IMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a bla CTX-M-15 FIB K /FII K plasmid in the referring hospital. Conclusions The data suggest the major source of K. pneumoniae was the patient's own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities.

AB - Background Klebsiella pneumoniae is a leading cause of extended-spectrum β-lactamase (ESBL)-producing hospital-associated infections, for which elderly patients are at increased risk. Methods We conducted a 1-year prospective cohort study, in which a third of patients admitted to 2 geriatric wards in a specialized hospital were recruited and screened for carriage of K. pneumoniae by microbiological culture. Clinical isolates were monitored via the hospital laboratory. Colonizing and clinical isolates were subjected to whole-genome sequencing and antimicrobial susceptibility testing. Results K. pneumoniae throat carriage prevalence was 4.1%, rectal carriage 10.8%, and ESBL carriage 1.7%, and the incidence of K. pneumoniae infection was 1.2%. The isolates were diverse, and most patients were colonized or infected with a unique phylogenetic lineage, with no evidence of transmission in the wards. ESBL strains carried bla CTX-M-15 and belonged to clones associated with hospital-acquired ESBL infections in other countries (sequence type [ST] 29, ST323, and ST340). One also carried the carbapenemase bla IMP-26. Genomic and epidemiological data provided evidence that ESBL strains were acquired in the referring hospital. Nanopore sequencing also identified strain-to-strain transmission of a bla CTX-M-15 FIB K /FII K plasmid in the referring hospital. Conclusions The data suggest the major source of K. pneumoniae was the patient's own gut microbiome, but ESBL strains were acquired in the referring hospital. This highlights the importance of the wider hospital network to understanding K. pneumoniae risk and infection prevention. Rectal screening for ESBL organisms on admission to geriatric wards could help inform patient management and infection control in such facilities.

KW - asymptomatic carriage

KW - genomic epidemiology

KW - geriatric care

KW - Klebsiella pneumoniae

KW - multidrug resistance

UR - http://www.scopus.com/inward/record.url?scp=85046168581&partnerID=8YFLogxK

U2 - 10.1093/cid/ciy027

DO - 10.1093/cid/ciy027

M3 - Article

VL - 67

SP - 161

EP - 170

JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

SN - 1058-4838

IS - 2

ER -