Virginia Mason Medical Center (VMMC) in Seattle, WA, has been investigating an outbreak of Klebsiella pneumoniae since October 2022, the source of which remains unknown. Locating the source of the outbreak may be crucial in stopping further spread, as it could indicate a gap in the facility's current cleanliness protocols, or an overuse of antibiotics, according to experts.

Virginia Mason Medical Center. Community Update: Klebsiella pneumoniae investigation at VMMC. June 7, 2023.

 

“This particular organ is not non-common—many people carry this organism as part of their normal bowel flora,” says Adrian Popp, MD, an infectious disease specialist affiliated with New York’s Huntington Hospital at Northwell Health. “But if this particular bacteria gets into places where it's not supposed to be—for example, into the lungs, causing pneumonia [or] into the urine, causing a urinary tract infection—then it becomes a pathogen…that… caus[es] disease.”

Some klebsiella are drug-resistant or considered “gram-negative.” This is harmful in healthcare settings, as it can diminish the integrity of antibiotic drugs and lifesaving healthcare interventions. This particular Klebsiella pneumoniae is drug-resistant to some antibiotics, according to the Public Health Department of Seattle & King County.

Centers for Disease Control and Prevention. Gram-negative Bacteria Infections in Healthcare Settings.

Effah CY, Sun T, Liu S, Wu Y. Klebsiella pneumoniae: An increasing threat to public health. Annals of Clinical Microbiology and Antimicrobials. 2020;19(1). doi:10.1186/s12941-019-0343-8

 

The VMMC investigation has confirmed 33 cases of Klebsiella pneumoniae in patients between October 2022 and May 4, 2023. Since the investigation began, nine of the 33 patients have died. Whether or not their deaths resulted from the bacteria or other factors is unknown.

Virginia Mason Medical Center. Community Update: Klebsiella pneumoniae investigation at VMMC. June 7, 2023.

 

“This is indeed an outbreak, where you may have had an original source—a person—with this bacteria, and from there, it’s spread from person to person,” says Popp. An investigation is necessary to determine exactly how the outbreak occurred, he adds.

 

What are the risks of Klebsiella pneumoniae in healthcare settings?

 

Klebsiella pneumoniae infections can cause a range of issues, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis, according to the Centers for Disease Control and Prevention (CDC). These can occur in healthcare settings where patients are treated for other conditions.

Centers for Disease Control and Prevention. Gram-negative Bacteria Infections in Healthcare Settings.

 

 

How does Klebsiella pneumoniae spread?

 

Klebsiella pneumoniae is not airborne but can be spread via person-to-person contact. This can occur, for example, when patients touch one another or when a doctor who handles more than one patient touches people with contaminated hands.

Those most vulnerable to infections include patients on ventilators, with intravenous catheters, or who have wounds, which may allow the bacteria to more directly enter the body if exposure occurs, according to the CDC. While other people may be less likely to contract the bacteria, they could still be a carrier if exposed and are not in the clear from harm, Popp says.

“You don't want anybody exposed to anything that's drug-resistant,” he adds. “Now, patients who have a weaker immunity for whatever reasons—cancer patients, transplant patients, patients who may be HIV-positive or have other types of immune deficiencies—if they get exposed to more resistant bacteria, they can get ill and can be more difficult to treat.”

For those impacted by VMMS’s Klebsiella pneumoniae outbreak, treatment involves specific antibiotics, like carbapenems, which the bacteria is not currently resistant to, according to the Public Health Department for Seattle & King County.

Public Health Insider: Official Insights from Public Health Seattle & King County Staff. Q & A ON RECENT KLEBSIELLA OUTBREAK AT VIRGINIA MASON MEDICAL CENTER.

 

For doctors entering and exiting infected patient rooms, the agency recommends strict adherence to handwashing and wearing gowns and gloves.

In addition to the above protocols, it is important for doctors to take inventory of how they prescribe antibiotics and if their patients are overusing medications, says Popp. If overuse has occurred, he adds that curtailing this for the future and prescribing lower doses (when still effective) can be essential to reducing the risk of future, more drug-resistant bacteria outbreaks.

In a June update on the situation, VMMC states that it is taking steps to reduce risks of further transmission by implementing increased safety controls, such as conducting environmental sampling, updating facility infrastructure, and reviewing its current cleaning practices. It is also working to identify the source of the outbreak and is partnering with the CDC, the Washington State Department of Health (DOH), and the Public Health Department of Seattle & King County to do so.

Virginia Mason Medical Center. Community Update: Klebsiella pneumoniae investigation at VMMC. June 7, 2023.

 

“If you have multiple cases of infection of a certain strain of bacteria, it raises questions about how that facility is run and if there are certain breaks in infection control that allowed transmission to occur where it shouldn't have,” says Popp. “That's why an analysis and investigation has to be done—in a detailed way—to figure out what, if anything, went wrong or what else can be done to prevent such transmission in the future.”