gms | German Medical Science

18th Symposium on Infections in the Immunocompromised Host

International Immunocompromised Host Society

15. to 17.06.2014, Berlin

An Outbreak of Nosocomial Infection Caused by Multidrugresistant (MDR) Klebsiella pneumoniae in the Largest Cancer Hospital in Russia

Meeting Abstract

  • N. Dmitrieva - N.N.Blokhin Cancer Research Center of Russia, Moscow, Russia
  • Z. Grigoryevskaya - Russia
  • I. Petukhova - Russia
  • N. Bagirova - Russia
  • I. Shilnikova - Russia
  • S. Dyakova - Russia

18th Symposium on Infections in the Immunocompromised Host. Berlin, 15.-17.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14ichs50

doi: 10.3205/14ichs50, urn:nbn:de:0183-14ichs500

Veröffentlicht: 3. Juni 2014

© 2014 Dmitrieva et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Purpose: To analyze the identity of MDR-Klebsiella pneumoniae strains isolated from patients and hospital environment during the outbreak in September 2013.

Methods: Total 35 MDR K.pneumonie isolates were analysed. 22 isolates were from patients after operations on the thorax admitted to surgical ICU (SICU), including 6 from blood, 9 from bronchoscopic materials, 5 from wounds and 2 from urine. 7 patients died from infection. 14 isolates were from objects in the SICU. Biotypes were determined in accordance with the 8-digit expert data processing system (MicroScan WalkAway, “Siemens”). Identification with MALDI-TOF mass-spectrometer (MS) (Microflex, “Bruker”) and cluster analysis by comparing the mass spectra obtained with the available databases using the software package MALDI Biotyper 3.0 was performed.

Results: 22 of 36 (61.1%) strains had 77744372 biotype (16 of them were from patients and 6 – from objects in SICU). 14 strains had biotype 77744272 (13 - from patients and 1 – from hospital environment). The only distinction between these biotypes was in kanamycin (K) resistance: K.pneumoniae biotype 77744372 was K-resistant, and biotype 77744272 was K-sensitive. All isolates of K.pneumonie analyzed were only sensitive to imipenem, amikacin and tigecycline.

Two separate MS-peaks (grey and brown) on dendrogram were found. The Grey peak was obtained for 1 strain isolated from a patient and was not phylogenetically close to other strains studied. The Brown peak accounted for all other studied strains (n=34, 97.1 %) and formed two branches. One branch was formed with one strain, isolated from 1 patient. The second branch included all other strains (n=33) (Figure 1 [Fig. 1]). 7 of them (21.2 %) were obtained from the hospital environment and 26 (78.8%) strains were obtained from patients. In turn, this branch (n=33) was divided to 2 sub-branches, one of which was formed with 7 strains closest to the collection mass spectra K.pneumoniae RV_BA_03_BLK and K.pneumoniae 37585 PFM. The second sub-branch was formed with 26 strains different from all available in the MALDI Biotyper 3,0 MS collection.

Conclusion: 26 of 35 (74.3 %) isolates of MDR K.pneumoniae with biotypes of 77744372 and 77744272, forming brown MS-peak, prevail in our clinic and present phylogeneticaly close microorganisms other than collection of mass-spectra. Thus, we are dealing with phylogeneticaly new strains to be studied and registered in MALDI Biotyper 3.0 system.