Preemptive isolation and active surveillance in the prevention and control of nosocomial infection reduce the incidence of carbapenem-resistant Enterobacteriaceae

2019 ◽  
Vol 51 (5) ◽  
pp. 377-379
Author(s):  
Qiqiang Liang ◽  
Chengmin Yan ◽  
Zhijiang Xu ◽  
Man Huang
Keyword(s):  
Nosocomial Infection ◽  
Active Surveillance ◽  
Prevention And Control ◽  
Carbapenem Resistant ◽  
And Control ◽  
Carbapenem Resistant Enterobacteriaceae

scholarly journals Epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and comparison of the phenotypic versus genotypic screening tests for the detection of carbapenemases at a tertiary level, academic hospital in Johannesburg, South Africa

2018 ◽  
Vol 33 (5) ◽  
Author(s):  
Teena S. M. Thomas ◽  
Adriano G. Duse
Keyword(s):  
South Africa ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Infection Type ◽  
Screening Tests ◽  
Infection Prevention And Control ◽  
Academic Hospital ◽  
Carbapenem Resistant ◽  
And Control ◽  
Carbapenem Resistant Enterobacteriaceae

Background: Carbapenem-resistant Enterobacteriaceae (CRE) cause significant infections and pose a threat to the viability of available antibiotics. Understanding the epidemiology of these infections will assist in guiding appropriate treatment and infection prevention and control (IPC) practices in an institution. In addition, the phenotypic carbapenemase-producing Enterobacteriaceae (CPE) screening tests are widely used in South Africa. However, there is no published literature on their performance against PCR in that setting. Therefore, CRE epidemiology and performance of the Modified Hodge with Imipenem and Imipenem + EDTA combined disk tests (CDT) was evaluated at a tertiary academic hospital in Johannesburg.Method: A retrospective collection of data was performed. Data from January 2015 to December 2016 of all clinical isolates that were CRE OR carbapenem-susceptible Enterobacteriaceae with at least one positive CPE screening test were collected. Information collected included the ward areas from which samples were sent, specimen type that cultured CRE, CRE identification and carbapenem MIC results, phenotypic and genotypic CPE results.Results: Certain ward areas recurred as predominant areas with CRE infection in the two-year period. The prominent sample types that cultured CRE, the predominant Enterobacteriaceae species and carbapenemases identified corresponded with national surveillance data. The predominant carbapenemase type and level of carbapenem resistance conferred changed within one year. The Hodge test performed poorly for carbapenemase detection. The CDT detected metallo-β-lactamases adequately.Conclusion: In this study, the use of the MHT to screen for CPEs performed poorly. Continued surveillance will (i) lead to an understanding of the patient population (including infection type) affected, (ii) detect changes in the carbapenemase profiles, and (iii) inform infection prevention and control and appropriate clinical management.

scholarly journals 493. Laboratory Evaluation and Epidemiology of Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae in Department of Veterans Affairs, 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S240-S241
Author(s):  
Christopher Pfeiffer ◽  
Holly B Williams ◽  
Hannah Flegal ◽  
J Stacey Klutts ◽  
Martin Evans ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Veterans Affairs ◽  
Screening Tests ◽  
Laboratory Evaluation ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Case Definitions ◽  
Carbapenem Resistant ◽  
And Control ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenemase-producing (CP)-carbapenem-resistant Enterobacteriaceae (CRE) pose a major threat to public health and are a priority target of national prevention and control efforts including within Department of Veterans Affairs (VA). The laboratory evaluation and epidemiology of CRE in VA is uncertain. Methods Using data from the Veterans Health Administration Corporate Data Warehouse, we identified all Veterans with ≥1 CRE result obtained during 2017 and reviewed their electronic health record. Two case definitions were used: (1) 2015 CDC CRE (Enterobacteriaceae resistant to any carbapenem or with documented carbapenemase production) and (2) 2017 VA CP-CRE (E. coli, Klebsiella spp., and Enterobacter spp. resistant to imipenem, meropenem, or doripenem or with documented carbapenemase production). Patients harboring carbapenemase-producers detected by rectal screening tests only were included. We reviewed patient charts whose isolates met both CRE definitions, extracting detailed microbiologic and travel data for the first positive 2017 result. Results We identified 904 unique Veterans with CRE; 577 (64%) patients had results meeting both CRE case definitions while 327 (36%) had results meeting CDC CRE criteria only (Figure 1). Of the 458 patients with clinical isolates meeting both case definitions, urine specimens predominated (64%) and were associated with the lowest crude 90-day mortality (16%); mortality was highest amongst patients with respiratory tract cultures (40%) and bloodstream isolates (34%) (Figure 2). Nearly half (48%) of VA CP-CRE were tested for carbapenemases (76% in-house; 24% send-out); of these, 75%tested positive with 78% being a KPC, 1% NDM, and 21% unspecified (Figure 3). Additionally, all 119 CRE carriers with an identified gene had KPC. Only 7 patients (1%) had documented overseas travel. Conclusion Currently the incidence of CP-CRE in the nation’s largest healthcare system is low relative to other problem pathogens such as MRSA and Clostridioides difficile but is associated with a high crude mortality especially with respiratory and bloodstream isolates. KPC comprised almost all carbapenemases identified. This provides an initial, granular snapshot of CRE in VA to serve as a roadmap for ongoing CP-CRE prevention and control. Disclosures All authors: No reported disclosures.

scholarly journals 526. Significant Reduction of Hospital Onset Carbapenem-Resistant Enterobacteriaceae Utilizing Infection Prevention Strategies: It takes a Village!

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S253-S253
Author(s):  
Kinta Alexander ◽  
Sean Brown ◽  
Scott Lorin ◽  
Brian Koll ◽  
Dana Mazo ◽  
...  
Keyword(s):  
Prevention And Control ◽  
Infection Prevention ◽  
Uv Light ◽  
Stable Solution ◽  
City Hospital ◽  
Intervention Period ◽  
Hospital Leadership ◽  
Carbapenem Resistant ◽  
And Control ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) is a Gram-negative bacteria and is considered one of the major challenges in healthcare worldwide. CRE has a high mortality rate, and the majority produce carbapenemase enzymes, which can be easily spread to other bacteria and patients. An inner-city hospital had a substantial decrease in CRE associated infections/colonization after the implementation of a multi-disciplinary process championed by hospital leadership and Infection Prevention (IP). Methods A quasi-experimental study of patients with hospital-onset CRE-positive cultures over Thirty-eight months was conducted. The pre-intervention period was from January 2015 to July 2016 and the post intervention period was from August 2016 to February 2018. The intervention comprised of a CRE prevention and control (CPC) bundle. The bundle comprised of hand hygiene, strict contact precautions, appropriate surveillance cultures and the cleaning of a patient’s environment and equipment with bleach. Hospital leadership implemented the CPC bundle during daily huddles with IP and department leaders with real-time identification and resolution of any barriers. The diligence of cleaning and disinfection was monitored using a transparent, easily cleanable and environmentally stable solution that fluoresces when exposed to UV light. The solution was used to mark standardized high touch surfaces and shared equipment in CRE patient rooms prior to terminal cleaning. These surfaces were evaluated with a UV light and used as an opportunity to educate staff on common cleaning oversight. Results Prior to implementation of the CPC bundle, there were 24 cases of CRE with a baseline rate of 2.40. After introducing the CPC bundle, there were 8 cases of CRE with a rate of 0.83 (P = 0.006). The CPC bundle was associated with a reduction in CRE cases by 67%. Conclusion A hospital-wide approach between multiple departments is critical for the success of CRE prevention and control. This study provides further evidence that a multi-faceted approach to monitoring compliance with the CPC bundle can help reduce the transmission of CRE. This approach can decrease the burden on the healthcare system and improve patient outcomes. Disclosures All authors: No reported disclosures.

Provider Role in Transmission of Carbapenem-Resistant Enterobacteriaceae

2017 ◽  
Vol 38 (11) ◽  
pp. 1329-1334 ◽  
Author(s):  
Marika E. Grabowski ◽  
Hyojung Kang ◽  
Kristen M. Wells ◽  
Costi D. Sifri ◽  
Amy J. Mathers ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Positive Culture ◽  
Transmission Risk ◽  
Incidence Density ◽  
Continuous Exposure ◽  
Carbapenem Resistant ◽  
Control Evaluation ◽  
Provider Role ◽  
And Control ◽  
Carbapenem Resistant Enterobacteriaceae

OBJECTIVEWe sought to evaluate the role healthcare providers play in carbapenem-resistant Enterobacteriaceae (CRE) acquisition among hospitalized patients.DESIGNA 1:4 case-control study with incidence density sampling.SETTINGAcademic healthcare center with regular CRE perirectal screening in high-risk units.PATIENTSWe included case patients with ≥1 negative CRE test followed by positive culture with a length of stay (LOS) >9 days. For controls, we included patients with ≥2 negative CRE tests and assignment to the same unit set as case patients with a LOS >9 days.METHODSControls were time-matched to each case patient. Case exposure was evaluated between days 2 and 9 before positive culture and control evaluation was based on maximizing overlap with the case window. Exposure sources were all CRE-colonized or -infected patients. Nonphysician providers were compared between study patients and sources during their evaluation windows. Dichotomous and continuous exposures were developed from the number of source-shared providers and were used in univariate and multivariate regression.RESULTSIn total, 121 cases and 484 controls were included. Multivariate analysis showed odds of dichotomous exposure (≥1 source-shared provider) of 2.27 (95% confidence interval [CI], 1.25–4.15; P=.006) for case patients compared to controls. Multivariate continuous exposure showed odds of 1.02 (95% CI, 1.01–1.03; P=.009) for case patients compared to controls.CONCLUSIONSPatients who acquire CRE during hospitalization are more likely to receive care from a provider caring for a patient with CRE than those patients who do not acquire CRE. These data support the importance of hand hygiene and cohorting measures for CRE patients to reduce transmission risk.Infect Control Hosp Epidemiol 2017;38:1329–1334

scholarly journals Changes in Prevalence of Nosocomial Infection Pre- and Post-COVID-19 pandemic from a Tertiary Hospital in China

2021 ◽  
Author(s):  
Chunmei Su ◽  
Zhiqin Zhang ◽  
Xu Zhao ◽  
Hanlin Peng ◽  
Yi Hong ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Nosocomial Infections ◽  
Prevention And Control ◽  
Control Measures ◽  
Gastrointestinal Infections ◽  
Effective Prevention ◽  
Oral Infections ◽  
Prevention And Control Measures ◽  
And Control ◽  
The Impact

Abstract Background: Nosocomial infections (NIs) are an important cause of mortality, and increasing evidence reveals that the prevalence of NIs can be reduced through effective prevention and control measures. The aim of this study was to investigate the impact of the prevention and control measures for the COVID-19 pandemic on NIs.Methods: A retrospective study was conducted to analyze the prevalence of NIs before and after COVID-19 pandemic for six months in the Children’s Hospital of Soochow University.Results: A total of 39,914 patients in 2019 and 34,645 patients in 2020 were admitted to the hospital during the study. There were 1.39% (481/34645) of patients with NIs in 2020, which was significantly lower than the 2.56% (1021/39914) of patients in 2019. The rate of critical and fatal cases was also decreased. Except for the ICU, the prevalence of nosocomial infection in most departments decreased from 2019 to 2020. Regarding the source of infections, a significant reduction was mainly observed in respiratory (0.99% vs 0.42%, p=0.000) and digestive tract (0.63% vs 0.14%, p=0.000). The microorganism analysis of respiratory infections indicated an obvious decline in acinetobacters and fungi. The most significant decline of pathogens in gastrointestinal infections was observed for rotavirus. The comparison of catheter-related nosocomial infections between 2019 and 2020 did not show significant differences. Conclusions: The prevention and control measures for the COVID-19 pandemic have reduced the nosocomial infection in almost all departments, except the ICU, mainly regarding respiratory, gastrointestinal, and oral infections, while catheter-related infections did not show any differences.

scholarly journals Validation and Extrapolation of a Multimodal Infection Prevention and Control Intervention on Carbapenem-Resistant Klebsiella pneumoniae in an Epidemic Region: A Historical Control Quasi-Experimental Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Yunqi Dai ◽  
Tianjiao Meng ◽  
Xiaoli Wang ◽  
Bin Tang ◽  
Feng Wang ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Baseline Period ◽  
Historical Control ◽  
Infection Prevention And Control ◽  
Intervention Period ◽  
Carbapenem Resistant ◽  
Quasi Experimental ◽  
And Control

Objective: To verify the effects of comprehensive infection prevention and control (IPC) interventions for the prevention of the cross-transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) within intensive care units (ICUs) in an epidemic region.Methods: A historical control, quasi-experimental design was performed. The study was conducted between January 2017 and December 2019, following the implementation of a multimodal IPC bundle. The baseline period was established from January 2013 to June 2013, when only basic IPC measures were applied.Results: A total of 748 patients were enrolled during the entire study. The incidence of ICU-acquired CRKP colonization/infection was 1.16 per 1,000 patient-days during the intervention period, compared with 10.19 per 1,000 patient-days during the baseline period (p = 0.002). The slope of the monthly incidence of CRKP at admission showed an increasing trend (p = 0.03). The incidence of ICU-acquired catheter-related bloodstream infections caused by CRKP decreased from 2.54 to 0.96 per 1,000 central-line-days (p = 0.08). Compliance with contact precautions and terminal room disinfection improved during the intervention period. All environmental surface culture samples acquired after terminal room disinfection were negative for CRKP.Conclusion: Our findings suggest that in epidemic settings, multimodal IPC intervention strategies and consistent monitoring of compliance, may limit the spread of CRKP in ICUs.

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