N11. HAI outbreaks (and other types of HAIs)
Abstract Submission
Becky A. Smith, MD
Medical Director Infection Prevention and Hospital Epidemiology, Associate Professor of Medicine
Duke University
Durham, NC
Disclosure: Nothing to disclose
Amy J. Mathers, MD, D(ABMM)
Associate Professor
University of Virginia
Charlottesville, Virginia
Disclosure: Accelerate Diagnostics: Consultant
Antimicrobial Resistance Services: Consultant
SeLux Diagnostics: Consultant, Research Grant
VenatoRx: Advisory Board
Shireen Kotay, PhD
Assistant Professor
University of Virginia
Charlottesville, VA
Disclosure: Nothing to disclose
Hardik Parikh, PhD
Research Scientist
University of Virginia
Charlottesville, VA
Disclosure: AMR Services: Independent Contractor
Katie E. Barry, MS
Labortory Scientist
University of Virginia
Charlottesville, VA
Disclosure: Nothing to disclose
Jessica Seidelman, MD, MPH
Medical Instructor
Duke University
Durham, NC
Disclosure: Nothing to disclose
Rachel Addison, MT (ASCP), MPH
Clinical Research Coordinator
Duke Center for Antimicrobial Stewardship and Infection Prevention
Durham, NC
Disclosure: Nothing to disclose
Kirk Huslage, RN, BSN, MSPH
Clinical Operations Director, Infection Prevention
Duke University
Durham, NC
Disclosure: Nothing to disclose
Christopher Sova, BSN, RN
Infection Preventionist
Duke University
Durham, NC
Disclosure: Nothing to disclose
Sarah S. Lewis, MD, MPH
Associate Professor of Medicine
Duke University
Durham, NC
Disclosure: Nothing to disclose
Background :
We evaluated the role of an in-room sink in NDM-1 K. pneumoniae(NDMKP) transmission.
Methods :
In 10/2017, Infection Prevention (IP) initiated weekly point prevalence rectal screening cultures in 4 ICUs. In 3/2018, IP launched an epidemiologic and environmental investigation following identification of a patient with NDMKP rectal colonization. Environmental samples including swabs of biofilm from drains and water from p-traps were obtained from the in-room sink. Illumina whole genome sequencing (WGS) was performed on all NDMKP patient and environmental isolates. Single nucleotide variants (SNVs) were identified against the reference Klebsiella pneumoniae strain MLST15 (NZ_CP022127), and isolates within 150 SNVs of each other were considered to be genomically related.
Results : Two patients were identified with NDMKP infection or colonization between July 2017 and March 2018. The index patient had prolonged hospitalization and developed NDMKP bacteremia on hospital day (HD) 30. Approximately 9 months later, the second patient was admitted to the same ICU room that had been occupied by the index patient for 13 days and was identified to have NDMKP rectal colonization on HD 5. Environmental samples from the in-room sink of the ICU room grew NDMKP. WGS demonstrated relatedness between NDMKP isolates from the 2 patients (112 SNV), the index patient and the sink (52 SNV), and the second patient and the sink (80 SNV). The in-room sink was replaced in 4/18 and no further cases of NDMKP infection or colonization have been identified at DUH in over 12 months.
Conclusion : We report an NDM-1 K. pneumoniae transmission event possibly related to a contaminated in-room sink drain. Remarkably, 9 months elapsed between the index case and the second case, with no additional interim cases detected on weekly point-prevalence screening or clinical cultures. The long duration of time between and the index patient, secondary case, and sink culture may explain why WGS showed relatedness but not identical clones. Education around sink use, design, and more effective cleaning strategies are needed to mitigate environment-to-patient transmission of CRO.