Jacky Meyer1, Marcus Kusiak1, Dr Freya Lanhgham1, Rebecca McNamara1, Melanie Jong1, Phoebe Wang1, Professor Rhonda L Stuart1,2,3
1Infection Prevention Monash Health, Melbourne, Australia, 2Public Health and Infection Prevention. Monash Health, Melbourne, Australia, 3Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Australia
Biography:
Jacky has been working in Infection Prevention at Monash Health for 10 years. She has a background in both adult and paediatric Intensive Care nursing, having worked in Australia the UK, and Fiji. She has extensive experience in outbreak management & investigation and a strong focus in Infection Prevention education.
Abstract:
Background
Carbapenemase-producing Enterobacterales are an increasing problem in Australia. Often seen in patients with a history of overseas healthcare exposure or travel, however, since 2014 there have been local healthcare outbreaks reported. We present an outbreak of OXA-181 carbapenemase-producing Klebsiella pneumoniae (K. pneumoniae) across multiple sites at a major health service in Melbourne, Victoria.
Action
Two seemingly epidemiologically unlinked OXA-181 clinical isolates were identified in May 2023. Subsequently in July 2023, a whole-genome sequencing research study retrospectively identified five closely related OXA-181 producing K. pneumoniae isolates which included the two initial isolates. These had not been detected on routine susceptibility testing as the meropenem MIC was <0.25 (considered susceptible). An Incident Management Team was established, and infection prevention measures were implemented.
Results
Due to delay in identification, the outbreak spread across four wards involving three hospital sites. This resulted in 123 room contacts, 1867 ward contacts and a total of 26 patients affected (colonised or infected). Following infection prevention interventions, further transmission ceased and the outbreak was closed in October 2023.
Conclusion
This outbreak was extending for some time prior to being detected due to the unique nature of the organism involved. In initiating a rapid multi-disciplinary response, the outbreak was brought under control with routine infection prevention measures. This highlights the importance of sequencing unusual organisms to identify outbreaks early and standard precautions, when maintained correctly, are an effective way to reduce transmission.