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Hospital outbreak sustained by Klebsiella pneumoniae sequence type 147 co-producing NDM-1 and OXA-48, Rome, Italy,
Valerio Capitani1, Mariateresa Ceparano1, Annalisa Rosso1
1Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy.
Abstract:
We describe an outbreak of carbapenemase-producing Klebsiella pneumoniae that occurred in February-March 2025 in a tertiary care hospital in Rome, Italy. Ten patients in two adjacent critical care units were found colonised or infected with strains co-producing NDM-1 and OXA-48 carbapenemases. Nine of these had acquired infections in our hospital and were detected through routine or enhanced rectal swab screening. Rapid implementation of infection prevention and control (IPC) measures, including patient cohorting, environmental cleaning and contact surveillance, helped contain transmission. Despite these measures, the outbreak spread across wards, suggesting challenges in timely isolation, patient movement within hospitals and contact precautions in intensive care units. Environmental sampling revealed a single surface contaminated with the outbreak strain. Rapid molecular typing using an in-house nanopore sequencing protocol (NanoTyping), supported by whole genome sequencing, confirmed clonal spread of the high-risk ST147 clone. Phylogenetic comparison with Italian isolates from previous outbreaks indicated regional dissemination of this clone. This outbreak highlights the need to combine genomic surveillance and rapid diagnostics to support real-time response. In settings with high multidrug-resistant organism (MDRO) prevalence, enhanced screening, routine surveillance and rigorous IPC protocols remain critical to prevent and control the spread of emerging high-risk clones in healthcare facilities.
Insights
An outbreak of carbapenemase-producing Klebsiella pneumoniae in Rome was contained using infection control measures. Genomic surveillance and rapid diagnostics are crucial for managing multidrug-resistant organism spread in hospitals.
Area of Science:
- Clinical microbiology
- Infectious disease epidemiology
- Genomic surveillance
Background:
- Carbapenemase-producing Klebsiella pneumoniae (CRKP) poses a significant threat in healthcare settings.
- Outbreaks of CRKP require rapid and effective infection prevention and control (IPC) strategies.
- Co-production of NDM-1 and OXA-48 carbapenemases represents a challenging multidrug-resistant organism (MDRO).
Purpose of the Study:
- To describe an outbreak of CRKP in a tertiary care hospital in Rome.
- To evaluate the effectiveness of IPC measures in containing the outbreak.
- To highlight the role of genomic surveillance in understanding CRKP dissemination.
Main Methods:
- Retrospective analysis of a CRKP outbreak spanning February-March 2025.
- Implementation and assessment of IPC measures: patient cohorting, environmental cleaning, contact surveillance.
- Rapid molecular typing (NanoTyping) and whole genome sequencing (WGS) for strain characterization and phylogenetic analysis.
- Environmental sampling for pathogen detection.
Main Results:
- Ten patients in critical care units were colonized or infected with NDM-1 and OXA-48 co-producing K. pneumoniae.
- Nine infections were hospital-acquired, detected via rectal swab screening.
- IPC measures contained initial transmission, but spread to other wards occurred.
- Genomic analysis confirmed clonal spread of the high-risk ST147 clone, with evidence of regional dissemination.
- A single contaminated environmental surface was identified.
Conclusions:
- Rapid implementation of IPC measures is vital but challenging in intensive care settings.
- Genomic surveillance combined with rapid diagnostics is essential for real-time outbreak response.
- Enhanced screening, routine surveillance, and rigorous IPC protocols are critical for preventing MDRO spread in healthcare facilities.
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