Active surveillance of carbapenem-resistant Enterobacteriaceae in intensive care units: Is it cost-effective in a nonendemic region?

2016 ◽  
Vol 44 (4) ◽  
pp. 394-399 ◽  
Author(s):  
Ka-wai Ho ◽  
Wai-tong Ng ◽  
Margaret Ip ◽  
Joyce H.S. You
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Active Surveillance ◽  
Cost Effective ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals How Long-Term Acute Care Hospitals Can Play an Important Role in Controlling Carbapenem-Resistant Enterobacteriaceae in a Region: A Simulation Modeling Study

2020 ◽  
Author(s):  
Bruce Y Lee ◽  
Sarah M Bartsch ◽  
Michael Y Lin ◽  
Lindsey Asti ◽  
Joel Welling ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Control Measures ◽  
Metropolitan Region ◽  
Drug Resistant ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Typically, long-term acute care hospitals (LTACHs) have less experience in and incentives to implementing aggressive infection control for drug-resistant organisms such as carbapenem-resistant Enterobacteriaceae (CRE) than acute care hospitals. Decision makers need to understand how implementing control measures in LTACHs can impact CRE spread regionwide. Using our Chicago metropolitan region agent-based model to simulate CRE spread and control, we estimated that a prevention bundle in only LTACHs decreased prevalence by a relative 4.6%–17.1%, averted 1,090–2,795 new carriers, 273–722 infections and 37–87 deaths over 3 years and saved $30.5–$69.1 million, compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased by a relative 21.2%. Adding LTACHs averted an additional 1,995 carriers, 513 infections, and 62 deaths, and saved $47.6 million beyond implementation in intensive care units alone. Thus, LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.

scholarly journals Increased Risk for Carbapenem-Resistant Enterobacteriaceae Colonization in Intensive Care Units after Hospitalization in Emergency Department

2020 ◽  
Vol 26 (6) ◽  
pp. 1156-1163 ◽  
Author(s):  
Matias Chiarastelli Salomão ◽  
Maristela Pinheiro Freire ◽  
Icaro Boszczowski ◽  
Sueli F. Raymundo ◽  
Ana Rubia Guedes ◽  
...  
Keyword(s):  
Emergency Department ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Carbapenem Resistant ◽  
Increased Risk ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals The Likelihood of Developing a Carbapenem-Resistant Enterobacteriaceae Infection during a Hospital Stay

2019 ◽  
Vol 63 (8) ◽  
Author(s):  
Pranita D. Tamma ◽  
Abida Kazmi ◽  
Yehudit Bergman ◽  
Katherine E. Goodman ◽  
Ernest Ekunseitan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Hospital Stay ◽  
Intensive Care Units ◽  
Median Time ◽  
Interquartile Range ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

ABSTRACT Of 1,455 unique patients in U.S. intensive care units (ICUs), 4% were rectally colonized with CRE on admission. A total of 297 patients were initially negative for carbapenem-resistant Enterobacteriaceae (CRE) and remained in the ICU long enough to contribute additional swabs; 22% of these patients had a subsequent CRE-positive swab, with a median time to CRE colonization of 13 days (interquartile range, 7 to 21 days). Patients colonized with carbapenemase-producing CRE were more likely than those colonized with non-carbapenemase-producing CRE to develop CRE infections during their hospitalizations (36% versus 3%; P < 0.05).

scholarly journals 535. Multicenter Study of the Prevalence of Rectal Colonization by Carbapenem-Resistant Enterobacteriaceae in Patients Admitted to the Intensive Care Units of 7 Major Hospitals in Kuwait

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S256-S256
Author(s):  
Amani Al Fadhli ◽  
Wafaa Y Jamal ◽  
Vincent O Rotimi
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Bacterial Species ◽  
Hospital Setting ◽  
Similarity Criterion ◽  
Teaching Hospitals ◽  
Carbapenem Resistant ◽  
Medical Icus ◽  
Rectal Colonization ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The emergence of carbapenem-resistant Enterobacteriaceae (CRE) has become an important epidemiological change in infectious diseases in the last 10 years. The gut is an important reservoir for these isolates thereby creating an opportunity for dissemination in a hospital setting especially the intensive care units (ICUs). The objective of this study was to investigate the colonization rates of patients, by CRE, admitted to the ICUs of 7 teaching hospitals. Methods Rectal swabs were collected during July 2017 to November 2018 from all patients on the day of ICU admission and 1 week after in each hospital. The samples were screened by direct plating on MacConkey agar containing 10-μg meropenem. Bacterial species identification was performed using the VITEK-2 system. The minimum inhibitory concentrations (MICs) of 14 antibiotics were determined by using Etest. Genes encoding carbapenem resistance was detected by PCR and sequencing. Their clonal relationship was determined by pulsed-field gel electrophoresis (PFGE). Results A total of 2580 Enterobacteriaceae were isolated from all patients. Seventy-four (2.9%) were confirmed as CRE most of which were from patients in Adan (AH: 36.5%) and Mubarak (MH: 46%) hospitals. Sixty (81.1%) harbored one or more of the tested carbapenemases genes. Forty-six (62.2%) carried blaOXA-181, 9 (12.2%) blaOXA-48, one blaKPC-2, while 14 (18.9%) carried 2 genes. Combinations of blaKPC-2 and blaOXA-181 genes were found in 5 (6.8%), blaVIM-1 and blaOXA-181 in 4 (5.4%), blaNDM-5 and blaOXA-181 in 3 (4.1%) and blaNDM-1 and blaOXA-181 in 2 (3.3%). The XbaI PFGE profile-based Dendrogram, at 85% similarity criterion, resolved 7 pulsotypes among isolates carrying blaOXA-181 in AH and MH designated A, B, C, D, E, F, and G. Further analysis revealed that 7 subpulsotypes A1, A2, A5, A6, C1, C2, and E1 were from unit D in the medical ICU of MH and A3, A4, B1, B3, D1, D2, D3, D4, F1, F2, F3, G1, and G2 were from surgical/medical ICUs in AH. 100% similarity was demonstrated among 8 isolates from AH and 2 from MH. Conclusion The prevalence of rectal colonization by CRE in the ICU patients was lower than expected. Detection of blaOXA-181 variety and blaNDM-5 is new to the milieu of genes so far described in isolates from Kuwait. Disclosures All authors: No reported disclosures.

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