A Klebsiella Outbreak in the Netherlands

In 2012, while living in Mozambique, I met a Dutch doctor named Koen Hulshof. We struck up a friendship and briefly worked together trying to help improve TB infection control practices at Maputo Central Hospital. Koen told me about how infectious disease control was conducted in the Netherlands and I was impressed. The Dutch seemed very organized and committed to making their health facilities safer. Now, 3 years later, I have a bit more public health/ ID experience under my belt and I still see the Dutch as infection control role models. For example, the following article about a outbreak of pan-resistant Klebsiella (KPC) affecting 6 patients in a nursing home and hospital in the Netherlands.

I’ll let you read the article yourself, but briefly, the outbreak was recognized in the summer of 2013 when a KPC isolate was detected in a 65-year-old man admitted to a large teaching hospital in the Netherlands. This event followed the repatriation of a 69-year-old woman from an ICU in Greece who had been found to be colonized with KPC. A total of 6 patients were eventually found to have KPC and the authors performed genomic typing/ whole genome sequencing (WGS) of the isolates. The authors also performed environmental cultures from patient rooms (bed, doorknob, etc) and common areas (table, keyboard, mouse, etc). Soberingly, extensive environmental contamination with KPC was found. Air sedimentation cultures were also taken by placing solid agar plates in areas of the hospital (footboard of the bed, on the sink, etc). Interestingly, KPC did grow in these air sedimentation cultures suggesting that the environment may not only be contaminated by direct contact, but also by droplets or other (airborne) particles. The authors opine, “To what extent this contributes to transmission is, as yet, unclear, and it should be noted that bacteria may survive longer on the sedimentation agars than on other inanimate surfaces.”

What lessons can we take away from this paper? Enterobacteraciae are invisible and contaminate the hospital environment. Transmission occurs when there are lapses in infection control. KPC is an ongoing threat that needs to be taken much more seriously. The possibility of droplet/airborne transmission needs investigation. There should be much more research on how to stop the nosocomial spread of KPC in hospitals and especially nursing homes, where transmission may be amplified. Anyone interested in infectious diseases epidemiology needs to make an effort to learn some genetics, because WGS is here to stay. And I need to book a plane ticket to Amsterdam to learn from my Dutch colleagues.

Screen Shot 2015-08-11 at 5.32.08 PM
Sequence of patient detection in the hospital and nursing home
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Environmental swabs, which were inoculated on CHROmagar and EbSA plates. Red indicated presence of KPC.

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