An Outbreak of NDM-1 Klebsiella pneumoniae in a Tertiary Care Hospital in British Columbia: The Role of Molecular Analysis in Determining Transmission
Bibliographic record
Abstract
Background. Carbapenemase-producing organisms (CPO) are considered a growing healthcare problem. We are reporting an outbreak of a New Delhi metallo-β-lactamase (NDM-1) producing Klebsiella pneumoniae that occurred at a major tertiary care facility in British Columbia from November 2013 to March 2014. Methods. Gram-negative bacilli from clinical and surveillance specimens were tested for carbapenem susceptibility by VITEK 2. Carbapenem non-susceptible organisms were further tested by E-test and ROSCO Neo-Sensitabs. PCR for carbapenemase genes was done on all carbapenem non-susceptible isolates. Pulsed field gel electrophoresis (PFGE) was performed on the isolates. Plasmid restriction fragment length polymorphism (RFLP) was done for carbapenemase producing plasmids using BglII. Results. A total of eleven patients were considered part of the K. pneumoniae NDM-1 outbreak on a medical unit. PFGE showed that the patients' isolates had 2 main clonal patterns. Plasmid analysis by PCR and RFLP was done and showed that 10 of the 11 cases had an NDM plasmid that belonged to the same major cluster (pNDM-BC-5). Two ICU patients had NDM-1 producing K. pneumoniae in clinical isolates but the plasmid belonged to a different major cluster (pNDM-BC-7) and they were not considered part of the outbreak. All patients colonized or infected with NDM producing K. pneumoniae were placed on contact precautions in single rooms. All positive patients were cohorted to one side of the outbreak unit. Nursing staff were also cohorted into a clean cohort and an outbreak cohort. Weekly point prevalence screens were conducted. Targeted surveillance of all admitted patients was started in March 2014 within all hospitals in the health authority. These combined measures resulted in halting transmission and the outbreak was declared over on March 10, 2014. Conclusion. Institutions that serve populations who frequently travel to regions where carbapenemase-producing organisms are endemic should have a robust surveillance and containment system for these organisms. Active surveillance and staff cohorting are important infection control measures. Molecular tools are helpful in understanding the patterns of transmission of these organisms and assisting with control measures. Disclosures. All authors: No reported disclosures.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".