n South African Medical Journal - Molecular characterisation and epidemiological investigation of an outbreak of carbapenemase-producing isolates of Kleb in South Africa : research

Volume 105, Issue 12
  • ISSN : 0256-9574
  • E-ISSN: 2078-5135



Klebsiella pneumoniae is an opportunistic pathogen often associated with nosocomial infections. A suspected outbreak of isolates, exhibiting reduced susceptibility to carbapenem antibiotics, was detected during the month of May 2012 among patients admitted to a haematology unit of a tertiary academic hospital in Cape Town, South Africa (SA).

An investigation was done to determine possible epidemiological links between the case patients and to describe the mechanisms of carbapenem resistance of these bacterial isolates.
Relevant demographic, clinical and laboratory information was extracted from hospital records and an observational review of infection prevention and control practices in the affected unit was performed. Antimicrobial susceptibility testing including phenotypictesting and genotypic detection of the most commonly described carbapenemase genes was done. The phylogenetic relationship of all isolates containing the carbapenemase gene was determined by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing.
Polymerase chain reaction analysis identified a total of seven -positive, carbapenem-resistant isolates obtained from seven patients, all from a single unit. These isolates were indistinguishable using PFGE analysis and belonged to sequence type ST-14. No other carbapenemase enzymes were detected.
This is the first documented laboratory-confirmed outbreak of OXA-181-producing in SA, and highlights the importance of enforcing strict adherence to infection control procedures and the need for ongoing surveillance of antibiotic-resistant pathogens in local hospitals.

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