BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) are an important and increasing threat to public health. In hospitals and long-term care facilities, carriers should be identified to prevent transmission; however, guidelines for infection control are not applicable to all types of care homes. AIM To report the outbreak investigation of a VIM-metallo-β-lactamase-producing Escherichia coli in a Dutch residential care home, where residents lived in private apartments but also used shared facilities. METHODS Contact and environmental screening rounds were performed to assess carriage and colonization rates. Due to the domestic characteristics of the home, customized infection control measures were needed. A bundle of interventions was implemented, including contact precautions, improved hygiene and education. FINDINGS In total, eight CPE carriers, including the index case, were identified among 110 residents. VIM-CPE spread was associated with the use of shared toilets in communal areas. Seven months after the first finding, all carriers were found to be VIM-negative, and after 1 year, VIM CPE was no longer detectable in the environment. CONCLUSION A customized bundled approach was needed to control the outbreak successfully. Current guidelines should be adapted to be suitable for all types of residential care homes in order to combat the spread of multi-resistant pathogens effectively.

中文翻译：

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在荷兰的一所养老院中，产生VIM-卡巴内酶的大肠杆菌。

背景技术产生碳青霉烯酶的肠杆菌科（CPE）是对公共健康的重要且日益增加的威胁。在医院和长期护理机构中，应确定携带者以防止传播；但是，感染控制准则并不适用于所有类型的疗养院。目的报告在荷兰的一家养老院中发生的一种生产VIM-金属-β-内酰胺酶的大肠杆菌的暴发调查，该院的居民居住在私人公寓中，但也使用共用设施。方法进行接触和环境筛选轮次以评估运输和定殖率。由于房屋的家庭特征，需要定制的感染控制措施。实施了一系列干预措施，包括接触预防措施，改善卫生状况和教育。调查结果 在110名居民中确定了8家CPE承运商，包括索引案例。VIM-CPE的传播与在公共区域使用共用厕所有关。首次发现七个月后，发现所有携带者均为VIM阴性，一年后，在环境中不再可检测到VIM CPE。结论需要使用定制的捆绑方法来成功控制爆发。当前的指南应进行修改以适合所有类型的寄宿家庭，以有效地抵抗多重耐药病原体的传播。在环境中不再可以检测到VIM CPE。结论需要使用定制的捆绑方法来成功控制爆发。当前的指南应进行修改以适合所有类型的寄宿家庭，以有效地抵抗多重耐药病原体的传播。在环境中不再可以检测到VIM CPE。结论需要使用定制的捆绑方法来成功控制爆发。当前的指南应进行修改以适合所有类型的寄宿家庭，以有效地抵抗多重耐药病原体的传播。