Brian Kristensen: Outbreak - a case

1. OUTBREAK
- A CASE
Brian Kristensen
Head, senior consultant, phd
National Center for Infection Control
Infection preparedness

2. CPO SITUATION IN DENMARK; FIRST PHASE
Outbreak case,St Petersburg December 2019
For all cases – apart from one -,
a travel history could be found
Carbapenem-producing
enterobacteriae (CPE)
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3. THE CASE
The setting: ≈ 830-bed university hospital with all medical specialities (no
transplantation unit). CPO has never been found before
October 2012: a meropenem-resistant C. freundii was detected in a urine
sample from a patient hospitalized in the haematology ward. The patient
had no history of travel
Will you
- Isolate the patient?
- Screen other patients for CPE?
- Send the isolate to further typing and confirmation
Outbreak case,St Petersburg December 2019 3

4. 12 MONTHS LATER
4 cases of the same type – NDM-1 producing C. freundii – at
haemotology ward, 2 cases with bacteremia, one dead.
Will you
- Isolate the patient?
- Screen other patients for CPE?
- Screen the environment
- Change your cleaning and disinfection practice
- screen hospital care workers
- inform your hospital manager?
- inform the public?
vvv
Outbreak case,St Petersburg December 2019 4

5. INTERVENTIONS 1ST PHASE
Screening of patients
- Rectal swab from all patients admitted and discharged – 4 week period
- 64 patients screened: no new positive
Screening of environments
From zink and toilets: all negative
What kind of screening method do you use
- PCR, fluorescent plates, other?
- How do you define your patients to be screened
• All?
• Admittance,
• Discharged
• Do not screen?
Outbreak case,St Petersburg December 2019 5

6. 30 MONTHS LATER
What about other departments?
What about the numerous species?
Outbreak case,St Petersburg December 2019 6

7. 7 YEARS LATER: 25 PATIENTS, SAME PATHOGEN
Is it still an epicemic? Or is it endemic?
Do the graph tell you something new?
Would you inform your colleaques in the other region
Outbreak case,St Petersburg December 2019
Female
Male
ICU Abdominal
surgical
department
Haematology
department
Haematology
department in
another
region
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8. TENTATIVE CONCLUSIONS: 35 PATIENTS
Spreading of both the same bacteria (C. freundii) and the same plasmid
including other species (K. pneumoniae, E. coli)
Several outbreaks
- 1st phase: Haematology dept
- 2nd phase: Abdominal surgery (centered about patients in a
specialized endoscopy room)
- 3rd phase: re-introduction in Haemotology wards
- 4th phase: endemic, un-recognized carriers
Some patients have carried the clone for more than 5 years
Whole-genome-sequencing has been valuable
Outbreak case,St Petersburg December 2019 8

9. USE OF WGS
WGS show clustering
both in time and
geography
Outbreak case,St Petersburg December 2019 9

10. CARBAPENEM-PRODUCING ENTEROBACTERIAE IN
DENMARK
Outbreak case,St Petersburg December 2019
Carbapenem-producing
enterobacteriae (CPE)
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