Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

AbstractBackgroundAccording to the European Center for Disease Prevention and Control (ECDC), the EU records an estimated 3.2 million healthcare associated infections (HAIs) and an associated 37,000 deaths annually. A significant proportion of the HAIs burden is attributable to multi-drug resistant pathogens. Infectious diseases remain top on the list of the leading causes of death globally with multi-drug resistant microorganisms (MDROs) playing a significant role.AimsTo assess the breadth of studies on antibiotics stewardship C. diff and Klebsiella pneumoniae in healthcare settings. To identify existing literature on the interventions for reducing healthcare associated C. diff and Klebsiella pneumoniae transmission.MethodsThis scoping review was undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines. The specific databases searched included MEDLINE, PubMed, Web of Science Core Collection, and CINAHL. The process for screening articles and data extraction was undertaken in duplicate by two reviewers. A narrative synthesis of the results is provided.ResultsThe review included 34 studies (16 studies on Clostridium difficile and 18 articles focussed on Klebsiella pneumoniae). These interventions include Education, Surveillance/Screening, Consultations, Audits, Policies/Protocols, Environmental disinfection, Bundles, Isolation, and Notifications or alerts (ESCAPE-BIN). A study involving screening, alerts, staff education, and antimicrobial protocols recorded a 75% reduction in the use of targeted antimicrobials. The largest absolute reduction in antimicrobial use of 310 DDs/1000PDs was reported from an intervention that involved audits and feedback systems. The highest improvement (95%) in adherence was reported by an intervention involving the use of an infection prevention bundle and an environmental cleaning protocol.ConclusionAntimicrobial resistance represents a global threat requiring urgent measures to protect lives. Reducing the burden of AMR entails a host of multi-level approaches aimed at curbing transmission of the resistant pathogens, and optimizing the use of antibiotics.

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Antimicrobial stewardship and infection prevention interventions targeting healthcare-associated Clostridioides difficile and carbapenem-resistant Klebsiella pneumoniae infections: a scoping review

BMJ Open ◽

10.1136/bmjopen-2021-051983 ◽

2021 ◽

Vol 11 (8) ◽

pp. e051983

Author(s):

Bernard Ojiambo Okeah ◽

Valerie Morrison ◽

Jaci C Huws

Keyword(s):

Klebsiella Pneumoniae ◽

Behaviour Change ◽

Scoping Review ◽

Infection Prevention ◽

Antimicrobial Use ◽

Healthcare Settings ◽

Clostridioides Difficile ◽

Carbapenem Resistant ◽

Change Principles ◽

Healthcare Associated

ObjectivesThis study assessed antimicrobial stewardship (AMS) and infection prevention (IP) interventions targeting healthcare-associated Clostridioides difficile and carbapenem-resistant Klebsiella pneumoniae (CRKP) infections, their key outcomes and the application of behaviour change principles in these interventions.DesignThis scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR) guidelines while focusing on acute healthcare settings in both low-to-middle income and high-income countries.Data sourcesThe databases searched were MEDLINE, PubMed, Web of Science and CINAHL between 22 April 2020 and 30 September 2020.EligibilityThe review included peer-reviewed articles published in English language between 2010 and 2019. Studies that focussed on IP and/or AMS interventions primarily targeting C. difficile or CRKP were included. Studies that assessed effectiveness of diagnostic devices or treatment options were excluded from this review.Data extraction and synthesisAn abstraction sheet calibrated for this study was used to extract data on the main study characteristics including the population, intervention and outcomes of interest (antimicrobial use, compliance with IP interventions and risk for C. difficile and CRKP). A narrative synthesis of the results is provided.ResultsThe review included 34 studies. Analysis indicates that interventions targeting C. difficile and CRKP include Education, Surveillance/Screening, Consultations, Audits, Policies and Protocols, Environmental measures, Bundles, Isolation as well as Notifications or alerts (represented using the ESCAPE-BIN acronym). The identified outcomes include antimicrobial use, resistance rates, risk reduction, adherence to contact precautions, hospital stay and time savings. AMS and IP interventions tend to be more adhoc with limited application of behaviour change principles.ConclusionThis scoping review identified the AMS and IP interventions targeting C. difficile and CRKP in healthcare settings and described their key outcomes. The application of behaviour change principles in AMS and IP interventions appears to be limited.

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Persisting intrahospital transmission of multidrug-resistant Klebsiella pneumoniae and challenges for infection control

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.153 ◽

2019 ◽

Vol 40 (8) ◽

pp. 904-909 ◽

Cited By ~ 1

Author(s):

Isabelle Vock ◽

Sarah Tschudin-Sutter

Keyword(s):

Klebsiella Pneumoniae ◽

Infection Control ◽

Multidrug Resistant ◽

Global Scale ◽

Resistance Mechanisms ◽

Healthcare Associated Infections ◽

The Past ◽

Healthcare Settings ◽

Healthcare Associated ◽

Antibiotic Agents

AbstractIn the past several decades, the incidence of Klebsiella pneumoniae harboring resistance mechanisms against multiple antibiotic agents has increased on a global scale. We discuss reasons for ongoing transmission of multidrug-resistant K. pneumoniae in healthcare settings, which has resulted in the successful spread and establishment of this pathogen. It is now one of the most important causes of healthcare-associated infections worldwide.

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Role of pulsed-xenon ultraviolet light in reducing healthcare-associated infections: a systematic review and meta-analysis

Epidemiology and Infection ◽

10.1017/s095026882000148x ◽

2020 ◽

Vol 148 ◽

Author(s):

Zhenhong Dong ◽

Na Zhou ◽

Guijuan Liu ◽

Li Zhao

Keyword(s):

Systematic Review ◽

Ultraviolet Light ◽

Meta Analysis ◽

Pooled Analysis ◽

Current Evidence ◽

Healthcare Associated Infections ◽

Infection Rates ◽

Healthcare Settings ◽

Meta Regression Analysis ◽

Healthcare Associated

Abstract Pulsed-xenon-ultraviolet light (PX-UVL) is increasingly used as a supplemental disinfection method in healthcare settings. We undertook a systematic search of the literature through several databases and conducted a meta-analysis to evaluate the efficacy of PX-UVL in reducing healthcare-associated infections. Eleven studies were included in the systematic review and nine in the meta-analysis. Pooled analysis of seven studies with before-after data indicated a statistically significant reduction of Clostridium difficile infection (CDI) rates with the use of the PX-UVL (incidence rate ratio (IRR): 0.73, 95% CI 0.57–0.94, I2 = 72%, P = 0.01), and four studies reported a reduction of risk of methicillin-resistant Staphylococcus aureus (MRSA) infections (IRR: 0.79, 95% CI 0.64–0.98, I2 = 35%, P = 0.03). However, a further four trials found no significant reduction in vancomycin-resistant enterococci (VRE) infection rates (IRR: 0.80, 95% CI 0.63–1.01, I2 = 60%, P = 0.06). The results for CDI and MRSA proved unstable on sensitivity analysis. Meta-regression analysis did not demonstrate any influence of study duration or intervention duration on CDI rates. We conclude that the use of PX-UVL, in addition to standard disinfection protocols, may help to reduce the incidence of CDI and MRSA but not VRE infection rates. However, the quality of evidence is not high, with unstable results and wide confidence intervals, and further high-quality studies are required to supplement the current evidence.

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Clinical characteristics of patients with pneumonia caused by Klebsiella pneumoniae in Taiwan and prevalence of antimicrobial-resistant and hypervirulent strains: a retrospective study

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-019-0660-x ◽

2020 ◽

Vol 9 (1) ◽

Cited By ~ 2

Author(s):

Chih-Han Juan ◽

Shih-Yu Fang ◽

Chia-Hsin Chou ◽

Tsung-Ying Tsai ◽

Yi-Tsung Lin

Keyword(s):

Retrospective Study ◽

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Community Acquired Pneumonia ◽

Drug Resistant ◽

Hospital Acquired Pneumonia ◽

Resistant Strains ◽

Healthcare Associated ◽

Drug Resistant Strains ◽

Hospital Acquired

Abstract Background We aimed to compare the clinical characteristics of patients with community-acquired pneumonia (CAP), healthcare-associated pneumonia (HCAP), and hospital-acquired pneumonia (HAP) caused by Klebsiella pneumoniae and analyze the antimicrobial resistance and proportion of hypervirluent strains of the microbial isolates. Methods We conducted a retrospective study on patients with pneumonia caused by K. pneumoniae at the Taipei Veterans General Hospital in Taiwan between January 2014 and December 2016. To analyze the clinical characteristics of these patients, data was extracted from their medical records. K. pneumoniae strains were subjected to antimicrobial susceptibility testing, capsular genotyping and detection of the rmpA and rmpA2 genes to identify hypervirulent strains. Results We identified 276 patients with pneumonia caused by K. pneumoniae, of which 68 (24.6%), 74 (26.8%), and 134 (48.6%) presented with CAP, HCAP, and HAP, respectively. The 28-day mortality was highest in the HAP group (39.6%), followed by the HCAP (29.7%) and CAP (27.9%) groups. The HAP group also featured the highest proportion of multi-drug resistant strains (49.3%), followed by the HCAP (36.5%) and CAP groups (10.3%), while the CAP group had the highest proportion of hypervirulent strains (79.4%), followed by the HCAP (55.4%) and HAP groups (41.0%). Conclusion Pneumonia caused by K. pneumoniae was associated with a high mortality. Importantly, multi-drug resistant strains were also detected in patients with CAP. Hypervirulent strains were prevalent in all 3 groups of pneumonia patients, even in those with HAP.

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Risk Factors of Klebsiella pneumoniae Infections in Pediatric Healthcare Settings

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2020-20-2-40-47 ◽

2020 ◽

Vol 19 (2) ◽

pp. 40-47

Author(s):

S. A. Kuzmenko ◽

M. A. Shmakova ◽

E. B. Brusina

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Assisted Ventilation ◽

Antimicrobial Treatment ◽

Klebsiella Pneumonia ◽

Healthcare Settings ◽

Increased Risk ◽

Healthcare Associated ◽

Pediatric Healthcare ◽

Klebsiella Spp

Relevance. Klebsiella pneumoniae is a major cause of severe healthcare-associated infections in children, representing one of the six most widespread multidrug-resistant microorganisms worldwide and requiring the implementation of population-wide treatment strategies.Aim. To study the risk factors for Klebsiella spread in pediatric healthcare settings.Materials and Methods. Here we performed a descriptive retrospective epidemiological study of Klebsiella spp. cases in pediatric units across the entire Kemerovo region (2012–2019). In total, we documented 27,852 treatment outcomes. We further selected 52 confirmed cases and assessed their risk profiles in comparison with 738 condition-matched control children.Results. Average incidence of Klebsiella spp. detection in pediatric healthcare settings was 78.52 per 1,000 patients (95% CI = 75.42–81.74). We revealed a declining incidence of Klebsiella pneumoniae infection in the region, with notable 4-year cyclicity. The proportion of Klebsiella pneumoniae-infected patients increased 2-fold after 5 days of antibiotic therapy. Among the risk factors of Klebsiella pneumonia infection were artificial feeding (OR = 9,21, 95% = 3,31–35,45, р = 0,0001), assisted ventilation (OR = 7,36, 95% CI = 3,92–14,0], р = 0,0001), use of nebulizers (OR = 5,34, 95% CI =2,49 – 10,9], р=0,0001), airway management (OR = 4,62, 95% CI =2,49–8,56, р = 0,0001), preterm birth (OR = 2,55, 95% CI =1,38 – 4,69, р=0,001), low body weight (OR = 2,48, 95% CI = 1,34–4,56, р = 0,002), enema administration (OR = 1,80, 95% CI = 0,78–3,81, р = 0,088), and nasogastric intubation (OR = 1,79, 95% CI = 0,85–3,54, р = 0,065).Conclusions. The incidence of Klebsiella pneumoniae infections is currently lowering and has 4-year cyclicity. Antimicrobial treatment is associated with 2-fold increased risk if administered for ≥ 5 days. A number of healthcare-associated risk factors of Klebsiella pneumoniae infections have been found.

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The incubation period of COVID-19: A scoping review and meta-analysis to aid modelling and planning

10.1101/2020.10.20.20216143 ◽

2020 ◽

Author(s):

Prakashini Banka ◽

Catherine Comiskey

Keyword(s):

Incubation Period ◽

Scoping Review ◽

Meta Analysis ◽

Accurate Estimate ◽

Mitigation Strategies ◽

Global Index ◽

Distribution Modelling ◽

Period Distribution ◽

Incubation Periods ◽

The Mean

AbstractBackgroundAn accurate estimate of the distribution of the incubation period for COVID-19 is the foundational building block for modelling the spread of the SARS COV2 and the effectiveness of mitigation strategies on affected communities. Initial estimates were based on early infections, the aim of this study was to provide an updated estimate and meta-analysis of the incubation period distribution for COVID-19.MethodsThe review was conducted according to the PRISMA Scoping Review guidelines. Five databases were searched; CINAHL, MEDLINE, PUBMED, EMBASE, ASSIA, and Global Index Medicus for studies published between 1 January 2020 - 27 July 2020.ResultsA total of 1,084 articles were identified through the database searches and 1 article was identified through the reference screening of retrieved articles. After screening 64 articles were included. The studies combined had a sample of 45,151 people. The mean of the incubation periods was 6.71 days with 95% CIs ranging from 1 to 12.4 days. The median was 6 days and IQR ranging from 1.8 to 16.3. The resulting parameters for a Gamma Distribution modelling the incubation period were Γ(α, λ) = Γ(2.810,0.419) with mean, μ = α/λ.ConclusionGovernments are planning their strategies on a maximum incubation period of 14 days. While our results are limited to primarily Chinese research studies, the findings highlight the variability in the mean period and the potential for further incubation beyond 14 days. There is an ongoing need for detailed surveillance on the timing of self-isolation periods and related measures protecting communities as incubation periods may be longer.

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Healing Architecture in Healthcare: A Scoping Review

HERD Health Environments Research & Design Journal ◽

10.1177/19375867211072513 ◽

2022 ◽

pp. 193758672110725

Author(s):

Thorben Simonsen ◽

Jodi Sturge ◽

Cameron Duff

Keyword(s):

Scoping Review ◽

Spatial Organization ◽

Evidence Synthesis ◽

Meta Analysis ◽

Clinical Practices ◽

Decision Tool ◽

Healthcare Settings ◽

Scoping Reviews ◽

Definition Of ◽

Methodological Guidelines

Objectives: The purpose of this scoping review is to identify evidence on how characteristics of healing architecture in clinical contexts impact clinical practice and patient experiences. Based on these insights, we advance a more practice-based approach to the study of how healing architectures work. Background: The notion of “healing architecture” has recently emerged in discussions of the spatial organization of healthcare settings, particularly in the Nordic countries. This scoping review summarizes findings from seven articles which specifically describe how patients and staff experience characteristics of healing architecture. Methods: This scoping review was conducted using the framework developed by Arksey and O’Malley. We referred to the decision tool developed by Pollock et al. to confirm that this approach was the most appropriate evidence synthesis type to identify characteristics related to healing architecture and practice. To ensure the rigor of this review, we referred to the methodological guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews. Results: There are two main findings of the review. First, there is no common or operative definition of healing architecture used in the selected articles. Secondly, there is limited knowledge of how healing architecture shapes clinical and patient outcomes. Conclusions: We conclude that further research is needed into how healing architectures make a difference in everyday clinical practices, both to better inform the development of evidence-based designs in the future and to further elaborate criteria to guide postoccupancy evaluations of purpose-built sites.

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Impact of multi-drug resistant bacteria on economic and clinical outcomes of healthcare-associated infections in adults: Systematic review and meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0227139 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0227139 ◽

Cited By ~ 9

Author(s):

Miquel Serra-Burriel ◽

Matthew Keys ◽

Carlos Campillo-Artero ◽

Antonella Agodi ◽

Martina Barchitta ◽

...

Keyword(s):

Systematic Review ◽

Clinical Outcomes ◽

Meta Analysis ◽

Resistant Bacteria ◽

Healthcare Associated Infections ◽

Drug Resistant ◽

Drug Resistant Bacteria ◽

Healthcare Associated

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Risk Factors of Klebsiella pneumoniae Infections in Pediatric Healthcare Settings

Epidemiology and Vaccinal Prevention ◽

10.31631/2073-3046-2020-19-2-40-47 ◽

2020 ◽

Vol 19 (2) ◽

pp. 40-47

Author(s):

S. A. Kuzmenko ◽

M. A. Shmakova ◽

E. B. Brusina

Keyword(s):

Risk Factors ◽

Klebsiella Pneumoniae ◽

Assisted Ventilation ◽

Antimicrobial Treatment ◽

Klebsiella Pneumonia ◽

Healthcare Settings ◽

Increased Risk ◽

Healthcare Associated ◽

Pediatric Healthcare ◽

Klebsiella Spp

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Antibiotic Susceptibility of Klebsiella pneumoniae isolated from Selected Tertiary Hospitals in Osun State, Nigeria

Iraqi Journal of Science ◽

10.24996/ijs.2019.60.7.2 ◽

2019 ◽

pp. 1423-1429

Author(s):

Idowu Jesulayomi Adeosun ◽

Kolawole Elijah Oladipo ◽

Oluwatosin Akinola Ajibade ◽

Titilayo Mabel Olotu ◽

Abayomi A Oladipo ◽

...

Keyword(s):

Antibiotic Resistance ◽

Klebsiella Pneumoniae ◽

Diffusion Method ◽

Resistance Pattern ◽

Disk Diffusion Method ◽

Antibiotic Resistant ◽

Healthcare Settings ◽

Empiric Antibiotic ◽

Tertiary Hospitals ◽

Healthcare Associated

Klebsiella pneumoniae is a pathogen of the Enterobacteriaceae family that causes healthcare-associated infections and has recently emerged as one of the most antibiotic-resistant organisms responsible for outbreaks in both community and healthcare settings. The aim of this study is to determine the resistance pattern of Klebsiella pneumoniae isolated from selected tertiary hospitals in Osun state, Nigeria. A total of 62 Klebsiella pneumoniae isolates were obtained from 1056 samples of urine, wound swab, ear swab, eye swab and other collection sites that were routinely submitted to the diagnostic laboratories of the selected tertiaryhospitals. Susceptibility to twelve (12) antibiotics (Oxoid) was determined using the Kirby Bauer disk diffusion method for the 62 isolates. Rate of resistance to carbapenems, fluoroquinolones, polymyxins, monobactams, cephalosporins, penicillin and phosphonic acid derivative are 29.03%, 47.84%, 29.03%, 46.77%, 50.80%, 93.55%, and 37.10% respectively. The isolates were mostly susceptible to carbapenems, especially, Imipenem with 74.19%. Highest resistance was to Penicillin (93.55%). The multiple antibiotic resistance (MAR) index revealed that 52 (83.87%) out of 62 isolates were multi-drug resistant. Increase in antibiotic resistance continues to be a problem amidst patients infected with Klebsiella pneumoniae which can be most likely attributed to increase in antibiotic misapplication, misuse and abuse which is most prevalent among youths. It is therefore of utmost importance that consistent monitoring of antibiotic resistance be done as it will assist in the appropriate selection of empiric antibiotic treatment in the proper setting.

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