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Failure to Control an Outbreak of Multidrug-Resistant Streptococcus pneumoniae in a Long-Term–Care Facility Emergence and Ongoing Transmission of a Fluoroquinolone-Resistant Strain

Published online by Cambridge University Press:  21 June 2016

Rosalind J. Carter ,
Genevieve Sorenson ,
Richard Heffernan ,
Julia A. Kiehlbauch ,
John S. Kornblum ,
Robert J. Leggiadro ,
Lucia J. Nixon ,
William A. Wertheim ,
Cynthia G. Whitney  and
Marcelle Layton
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Rosalind J. Carter
Affiliation:
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, New York Epidemic Intelligence Service, Division of Applied Public Health Training, State Branch, Epidemiology Program Office, Atlanta, Georgia
Genevieve Sorenson
Affiliation:
St. Elizabeth Ann's Health Care and Rehabilitation Center, Staten Island, New York
Richard Heffernan
Affiliation:
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, New York
Julia A. Kiehlbauch
Affiliation:
Wadsworth Center, New York State Department of Health, Albany, New York
John S. Kornblum
Affiliation:
Public Health Laboratory, New York City Department of Health and Mental Hygiene, New York, New York
Robert J. Leggiadro
Affiliation:
St. Vincent's Medical Center, Staten Island, New York
Lucia J. Nixon
Affiliation:
St. Elizabeth Ann's Health Care and Rehabilitation Center, Staten Island, New York
William A. Wertheim
Affiliation:
State University of New York at Stonybrook, Stonybrook, New York
Cynthia G. Whitney
Affiliation:
Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
Marcelle Layton*
Affiliation:
Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, New York, New York
*
New York City Department of Health and Mental Hygiene, 125 Worth Street, Box 22A, New York, NY 10013[email protected]
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Abstract

Objectives:

To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistant Streptococcus pneumoniae (MDRSP) among AIDS patients in a long-term–care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain.

Design:

Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance.

Setting:

An 80-bed AIDS-care unit in an LTCF.

Participants:

Staff and residents on the unit.

Results:

From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n = 65) and staff (n = 70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized.

Conclusions:

Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 3 , March 2005 , pp. 248 - 255
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Whitney, CG, Farley, MM, Hadler, J, et al.Increasing prevalence of multidrug-resistant Streptococcus pneumoniae in the United States. N Engl J Med 2000;343:1917–1924.Google Scholar
2.Mandeli, LA, Bartlett, JG, Dowell, SF, et al.Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis 2003;37:1405–1433.CrossRefGoogle Scholar
3.Pietz, MW, McGee, L, Jorgensen, JH, et al.Levofloxacin-resistant invasive Streptococcus pneumoniae in the US: evidence for clonal spread and the impact of the conjugate pneumococcal vaccine. Antimicrob Agents Chemother. 2004;48:3491–3497.Google Scholar
4.Doern, GV, Brueggemann, AB, Huynh, H, Wingert, E. Antimicrobial resistance to Streptococcus pneumoniae in the United States, 1997-98. Emerg Infect Dis 1999;5:757–765.Google Scholar
5.Chen, DK, McGeer, A, de Azavedo, JC, Low, DE. Decreased susceptibility of Streptococcus pneumoniae to fluoroquinolones in Canada. N Engl J Med 1999;341:233–239.Google Scholar
6.Jones, RN, Pfaller, MA, Doern, GV. Comparative antimicrobial activity of trovafloxacin tested against 3049 Streptococcus pneumoniae isolates from the 1997-1998 respiratory infection season. Diagn Microbiol Infect Dis 1998;32:119–126.CrossRefGoogle ScholarPubMed
7.Sheppard, DC, Bartlett, KA, Lampiris, HW. Streptococcus pneumoniae transmission in chronic-care facilities: description of an outbreak and review of management strategies. Infect Control Hosp Epidemiol 1998; 19:851–853.Google Scholar
8.Kupronis, BA, Richards, CL, Whitney, CG. The Active Bacterial Core Surveillance Team: invasive pneumococcal disease in older adults residing in long-term care facilities and in the community. J Am Geriatr Soc 2003;51:1520–1525.Google Scholar
9.Nuorti, JP, Butler, JC, Crutcher, JM, et al.An outbreak of multidrug-resistant pneumococcal pneumonia and bacteremia among unvaccinated nursing home residents. N Engl J Med 1998;338:1861–1868.Google Scholar
10.Outbreaks of pneumococcal pneumonia among unvaccinated residents in chronic-care facilities: Massachusetts, October 1995, Oklahoma, February 1996, and Maryland, May-June 1996. MMWR 1997;46:60–62.Google Scholar
11.Gleich, S, Morad, Y, Echague, R, et al.Streptococcus pneumoniae serotype 4 outbreak in a home for the aged: report and review of recent outbreaks. Infect Control Hosp Epidemiol 2000;21:711–717.Google Scholar
12.Facklam, RR, Washington, JA. Streptococcus and related catalase-negative gram-positive cocci. In: Balows, A, Hausler, WJ, Herrmann, KL, Isenberg, HD, Shadomy, HJ, eds. Manual of Clinical Microbiology, ed. 5. Washington, DC: American Society for Microbiology; 1991:238–257.Google Scholar
13.Austrian, R. The quellung reaction, a neglected microbiologic technique. Mt Sinai J Med 1976;43:699–705.Google Scholar
14.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, ed. 5. Villanova, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M7-A4.Google Scholar
15.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Villanova, PA: National Committee for Clinical Laboratory Standards; 1995.Google Scholar
16.Jorgensen, JH, Ferraro, MJ, McElmeel, ML, Spargo, J, Swenson, JM, Tenover, FC. Detection of penicillin and extended-spectrum cephalosporin resistance among Streptococcus pneumoniae clinical isolates by use of the E-test. J Clin Microbiol 1994;32:159–163.CrossRefGoogle ScholarPubMed
17.Smith, CL, Cantor, CR. Purification, specific fragmentation, and separation of large DNA molecules. Methods Enzymol 1987;155:449–467.Google Scholar
18.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
19.Fry, AM, Udeagu, CCN, Soriano-Gabarro, M, et al.Persistence of fluoroquinolone-resistant, multidrug-resistant Streptococcus pneumoniae in a long-term-care facility: efforts to reduce intrafacility transmission. Infect Control Hosp Epidemiol 2005;26:239–247.CrossRefGoogle Scholar
20.Hoge, CW, Reichler, MR, Dominguez, EA, et al.An epidemic of pneumococcal disease in an overcrowded, inadequately ventilated jail. N Engl J Med 1994;331:643–648.Google Scholar
21.Unsworth, DJ, Rowen, D, Carne, C, Sonnex, C, Baglin, T, Brown, DL. Defective IgG2 response to Pneumovax in HIV seropositive patients. Genitourin Med 1993;69:373–376.Google ScholarPubMed
22.Reichler, MR, Allphin, AA, Breiman, RF, et al.The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio. J Infect Dis 1992;166:1346–1353.Google Scholar
23.Rauch, AM, O'Ryan, M, Van, R, Pickering, LK. Invasive disease due to multiply resistant Streptococcus pneumoniae in a Houston, Texas, daycare center. Am J Dis Child 1990;144:923–927.Google Scholar
24.Cherian, T, Steinhoff, MC, Harrison, LH, Rohn, D, McDougal, LK, Dick, J. A cluster of invasive pneumococcal disease in young children in child care. JAMA 1994;271:695–697.Google Scholar
25.Craig, AS, Erwin, P, Schaffner, W, et al.Carriage of multidrug-resistant Streptococcus pneumoniae and impact of chemoprophylaxis during an outbreak of meningitis at a day care center. Clin Infect Dis 1999;29: 1257–1264.Google Scholar
26.De Galan, BE, van Tilburg, PM, Sluijter, M, et al.Hospital-related outbreak of infection with multidrug-resistant Streptococcus pneumoniae in the Netherlands. J Hosp Infect 1999;42:185–192.Google Scholar
27.Hooper, DC. Mechanisms of action of antimicrobials: focus on fluoroquinolones. Clin Infect Dis 2001;32(suppl 1):S9–S15.Google Scholar
28.Davidson, R, Cavalcanti, R, Brunton, JL, et al.Resistance to levofloxacin and failure of treatment of pneumococcal pneumonia. N Engl J Med 2002;346:747–750.Google Scholar
29.Ho, PL, Tse, WS, Tsang, KW, et al.Risk factors of acquisition of levofloxacin-resistant Streptococcus pneumoniae: a case-control study. Clin Infect Dis 2001;32:701–707.CrossRefGoogle ScholarPubMed
30.Weiss, K, Restieri, C, Gauthier, R, et al.A nosocomial outbreak of fluo-roquinolone-resistant Streptococcus pneumoniae. Clin Infect Dis 2001; 33:517–522.Google Scholar
31.Broome, CV, Facklam, RR, Fraser, DW. Pneumococcal disease after pneumococcal vaccination: an alternative method to estimate the efficacy of pneumococcal vaccine. N Engl J Med 1980;303:549–552.Google Scholar
32.Shapiro, ED, Berg, AT, Austrian, R, et al.The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325:1453–1460.Google Scholar
33.Butler, JC, Breiman, RF, Campbell, JF, Lipman, HB, Broome, CV, Facklam, RR. Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993;270:1826–1831.Google Scholar
34.Dworkin, MS, Ward, JW, Hanson, DL, Jones, JL, Kaplan, JE. Pneumococcal disease among human immunodeficiency virus-infected persons: incidence, risk factors, and impact of vaccination. Clin Infect Dis 2001;32:794–800.Google Scholar
35.Breiman, RF, Keller, DW, Phelan, MA, et al.Evaluation of the 23-valent pneumococcal capsular polysaccharide vaccine for HIV-infected patients. Arch Intern Med 2000;160:2633–2638.Google Scholar
36.Guidelines for preventing opportunistic infections among HIV-infected persons: 2002 recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. MMWR 2002;51(RR-8):11–12.Google Scholar