Household Transmission of Carbapenemase-producing Klebsiella pneumoniae

et al. Quantitative nucleic acid sequence-based assay as a new molecular tool for the detection and quantifi cation of Leish-mania parasites in skin biopsies.ther observations on clinical, histopatho-logical, and immunological features of borderline disseminated cutaneous leish-maniasis caused by Leishmania (Leish-mania) amazonensis. leishmaniasis due to Leishmania (Leish-mania) amazonensis in Amazonian Brazil, and the signifi cance of a negative Monte-negro skin-test in human infections. To the Editor: Since its fi rst description in 2001, carbapenemase-producing Klebsiella pneumoniae has become a frequent nosocomial pathogen in the eastern United States (1). This bacterium was introduced into Israel in 2005 and is endemic now in several hospitals in the country (2). We recently documented transmission of this organism within a household, the source being a debilitated patient who returned home after a long hospitalization. A 73-year-old man had a urologic procedure (transurethral resection of the bladder neck) in a community hospital in early October 2007. He was initially evaluated on September 23, 2007, at an outpatient clinic where a routine urine sample was obtained for culture. Carbapenemase-producing K. pneumoniae was cultured. Identifi ca-tion and susceptibility testing of the isolate were completed by using the VITEK 2 system (bioMérieux, Marcy l'Etoile, France). K. pneumoniae car-bapenemase was confi rmed by using the modifi ed Hodge test (3). Two repeat urine cultures grew the same organism ; however, a stool culture was negative for carbapenemase-producing K. pneumoniae. The medical history of the patient included hypertension and carcinoma of the prostate gland that was treated with high-intensity focused ultrasound in May 2007, followed by transurethral resection of prostate in June 2007. The 2 procedures were performed in 2 different private hospitals, and each required a 24-hour hospitalization. No carbapenemase-producing K. pneu-moniae was documented in these hospitals. Two months before detection of carbapenemase-producing K. pneu-moniae, the patient received a 1-week course of oral amoxicillin-clavulanate for presumed urinary tract infection, although urine culture obtained on July 29, 2007 was sterile. A repeat urine culture 2 weeks later (August 13, 2007) remained sterile. Because the circumstances of strain acquisition and patient characteristics were not typical for epidemiology of carbapenemase-producing K. pneumoniae (3), he was further questioned about possible contacts of relevance. The patient disclosed that his wife, who had amyotrophic lateral sclerosis that required mechanical ventilation, had been hospitalized in a tertiary hospital in the Tel Aviv area for 9 weeks until July 19, 2007. After discharge, she has been staying at …