Inter-hospital outbreak of Klebsiella pneumoniae producing KPC-2 carbapenemase in Ireland

Dearbháile Morris*, Fiona Boyle, Carol Morris, Iris Condon, Anne Sophie Delannoy-Vieillard, Lorraine Power, Aliya Khan, Margaret Morris-Downes, Cathriona Finnegan, James Powell, Regina Monahan, Karen Burns, Nuala O'connell, Liz Boyle, Alan O'Gorman, Hilary Humphreys, Sylvain Brisse, Jane Turton, Neil Woodford, Martin Cormican

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

31 Citations (Scopus)


Objectives: To describe an outbreak of KPC-2-producing Klebsiella pneumoniae with inter-hospital spread and measures taken to control transmission. Methods: Between January and March 2011, 13 K. pneumoniae isolates were collected from nine patients at hospital A and two patients at hospital B. Meropenem, imipenem and ertapenem MICs were determined by Etest, carbapenemase production was confirmed by the modified Hodge method and by a disc synergy test, and confirmed carbapenemase producers were tested for the presence of carbapenemase-encoding genes by PCR. PFGE, plasmid analysis, multilocus variable-number tandem-repeat analysis (MLVA) and multilocus sequence typing (MLST) analysis were performed on all or a subset of isolates. Results: Meropenem, imipenem and ertapenem MICs were 4 to >32, 8-32 and >16 mg/L, respectively. PCR and sequencing confirmed the presence of blaKPC-2. PFGE identified four distinguishable (≥88%) pulsed-field profiles (PFPs). Isolates distinguishable by PFGE had identical MLVA profiles, and MLST analysis indicated all isolates belonged to the ST258 clone. Stringent infection prevention and control measures were implemented. Over a period of almost 8 months no further carbapenemase-producing Enterobacteriaceae (CPE) were isolated. However, KPC-2-producing K. pneumoniae was detected in two further patients in hospital A in August (PFP indistinguishable from previous isolates) and October 2011 (PFP similar to but distinguishable from previous isolates). Conclusions: Stringent infection prevention and control measures help contain CPE in the healthcare setting; however, in the case of hospital A, where CPE appears to be established in the population served, it may be virtually impossible to achieve eradication or avoid reintroduction into the hospital.

Original languageEnglish
Article numberdks239
Pages (from-to)2367-2372
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Issue number10
Publication statusPublished - Oct 2012


  • Antimicrobial resistance
  • Dissemination
  • K. pneumoniae


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