What lies beneath – ESBL Klebsiella pneumoniae outbreak in an Orthopaedic Trauma Ward -Investigation, Identification, Interrogation, Intervention

Ms Trish Hurst³, Dr Paul R Chapman³, Mrs Michelle Doidge³, Mrs Brigitte Brodie³, Mr   Haakon Bergh⁶, Dr Brian Forde², Dr  Patrick  Harris⁶, Dr Krispin  Hajkowicz³

¹Queensland Genomics, Herston, Australia
²University of Queensland Centre for Clinical Research, Herston, Australia
³Royal Brisbane And Women’s Hospital, Herston, Australia
⁴QIMR Berghofer Medical Research Institute, Herston, Australia
⁵Australian Infectious Diseases Research Centre (AIDRC), St Lucia, Australia
⁶Queensland Pathology, Herston, Australia

Background

In Feb 2021 a cluster of 3 Extended Spectrum Beta Lactamase (ESBL) Klebsiella pneumoniae (KP) cases was detected in an orthopaedic trauma ward. Whole Genome Sequencing (WGS) confirmed these isolates had the same genotype, ST13.  After two further cases, an outbreak was declared, the ward placed on Contact Precautions, and routine infection control interventions instigated.

Methods/actions

In Australia, routine drain surveillance is recommended during outbreaks of Carbapenemase Producing Enterobacterales (CPEs). Building upon prior research from the Royal Brisbane and Women’s Hospital (RBWH), we used WGS to enhance traditional environmental surveillance methods and identified a causal link between the source (bathroom floor-waste) and patients, guiding successful interventions. In March 2021, drain maintenance/decontamination (using sodium hydroxide with a 30-minute dwell followed by flushing) was implemented to remove biofilm and eradicate microorganisms.

Results

From December 2020 to April 2021 this burbling outbreak resulted in 10 patient isolates (3 clinical, 7 colonisations). Multiple environmental samples were collected yielding 3 ESBL KP results that were clonally identical to the patient isolates. WGS facilitated rapid source identification and expedient, targeted intervention minimising the time from outbreak onset to resolution. Post-intervention patient and environmental surveillance has yielded no further isolates or bioburden. Drain maintenance continues in this ward, with a risk-based program to be implemented across the organisation.

Conclusion

Drain surveillance and maintenance has been demonstrated to help resolve outbreaks of multiresistant organisms at RBWH.  They are simple and effective interventions that could be considered by infection preventionists for inclusion in an outbreak response.

Biography:

Trish has worked in Infection Prevention and Control for over 15 years in a variety of specialty areas including Oral Health, Aeromedical Retrieval and most recently as  Scientific Program Coordinator for the University of Queensland Centre for Clinical Research and Queensland Genomics in the field of microbial genomics.  She has now returned to her substantive position as CNC Infection Monitoring and Prevention Service at the RBWH to (co) lead the response at one of Queensland’s  designated   COVID-19 hospitals.  In her spare time, Trish enjoys swabbing drains in search of  interesting multi-drug resistant bacteria and taking long walks on the beach.