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Use of a cohorting-unit and systematic surveillance cultures to control a Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae outbreak. Infect Control Hosp Epidemiol 2019 Jul;40(7):767-773



Pubmed ID




Scopus ID

2-s2.0-85065637314 (requires institutional sign-in at Scopus site)   5 Citations


OBJECTIVE: Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms and the novel use of a cohorting unit for its control.

DESIGN: Observational study.

SETTING: A 566-room academic teaching facility in Milwaukee, Wisconsin.

PATIENTS: Solid-organ transplant recipients.

METHODS: Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.

RESULTS: A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.

CONCLUSIONS: A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

Author List

Reeme AE, Bowler SL, Buchan BW, Graham MB, Behrens E, Singh S, Hong JC, Arvan J, Hyke JW, Palen L, Savage S, Seliger H, Huerta S, Ledeboer NA, Kotay S, Mathers AJ, Cooper VS, Mustapha MM, Mettus RT, Doi Y, Munoz-Price LS


Blake W. Buchan PhD Professor in the Pathology department at Medical College of Wisconsin
Mary Beth Graham MD Associate Chief, Professor in the Medicine department at Medical College of Wisconsin
Nathan A. Ledeboer PhD Vice Chair, Professor in the Pathology department at Medical College of Wisconsin
Allison Reeme in the CTSI department at Medical College of Wisconsin - CTSI

MESH terms used to index this publication - Major topics in bold

Bacterial Proteins
Cross Infection
DNA, Bacterial
Disease Outbreaks
Electrophoresis, Gel, Pulsed-Field
Infection Control
Klebsiella Infections
Klebsiella pneumoniae
Middle Aged
Molecular Epidemiology
Patient Care Bundles