scholarly journals Spread of Carbapenem-Resistant Enterobacteriaceae in a Region, China: How to Control?

2021 ◽  
Author(s):  
Jiansheng Wang ◽  
Changfu Yin ◽  
Weiwei Yang ◽  
Yuanpeng Lv ◽  
Peng Zhao
Keyword(s):  
Average Length ◽  
Control Measures ◽  
Evidence Based ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Polymerase Chain ◽  
Record Review ◽  
Epidemiological Characteristics ◽  
Spearman’S Correlation ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background: The increasing number of carbapenem-resistant Enterobacteriaceae (CRE) has become a serious problem globally. This study aimed to elucidate their geographically epidemiological characteristics and explore evidence-based infection control measures.Methods: Carbapenem-resistant genes were identified by polymerase chain reaction (PCR) and sequencing. Bacterial genotyping was studied using multilocus sequence typing (MLST) and wzi typing. The transferability of carbapenemase genes was determined by a broth mating method. The relationships between the rates of antimicrobial consumption and the prevalence of CRE were performed by Pearson's or Spearman's correlation analyses. The elucidation of transmission and the evaluation of control measures involved in electronic medical record review, environmental cultures, and outbreak evolution. Results: A total of 930 phenotypically confirmed CRE isolates collected from 19 hospitals were genotypically characterised. K.pneumoniae (KP) and E.coli isolates were 787 (85.17%) and 96 (10.39%) among 924 carbapenemase-producing Enterobacteriaceae (CPE) isolates. Two major carbapenemase genes KPC-2 and NDM in CPE isolates accounted for 84.63% (n = 782) and 13.74% (n = 127). ST11 comprised 86.32% (631/731) of KPC-2 KP isolates. Wzi typing could discriminate ST11 KP clones and precisely track their transmission. Conjugation assays demonstrated that Some KPC-2- and NDM-bearing plasmids could be conjugatively transferred. The transferability was influenced by different STs and different wzis. CRE patients were becoming increasingly younger due to nosocomial CRE acquisition. The average length of hospitalization of these patients showed a downward trend mainly due to significant increases in voluntarily discharged rates and mortality rates. The frequent transfers of CRE patients between intra- and inter-hospitals were the main driving factors for the CRE increase. No associations between the rates of antibiotics consumption and CRE prevalence were observed. Evidence-based measures could effectively reduce the prevalence of ST11-wzi209 clone but failed to control the dissemination of ST11-wzi141 KP clone. Conclusions: Continued vigilance for the importations should be maintained. Coordinated regional interventions are urgently needed to reduce CRE threat.

scholarly journals Spread of Carbapenem-Resistant Enterobacteriaceae in a Region, China: How to Control?

2021 ◽  
Author(s):  
Jiansheng Wang ◽  
Changfu Yin ◽  
Weiwei Yang ◽  
Yuanpeng Lv ◽  
Peng Zhao
Keyword(s):  
Infection Control ◽  
Average Length ◽  
Mortality Rates ◽  
Control Measures ◽  
Evidence Based ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Epidemiological Characteristics ◽  
Length Of Hospitalization ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The increasing number of carbapenem-resistant Enterobacteriaceae (CRE) has become a serious problem globally. This study aimed to elucidate their geographically epidemiological characteristics and explore evidence-based infection control measures. Results A total of 930 phenotypically confirmed CRE isolates collected from 19 hospitals were genotypically characterised. K.pneumoniae (KP) and E.coli isolates were 787 (85.17%) and 96 (10.39%) among 924 carbapenemase-producing Enterobacteriaceae (CPE) isolates. Two major carbapenemase genes KPC-2 and NDM in CPE isolates accounted for 84.63% (n = 782) and 13.74% (n = 127). ST11 comprised 86.32% (631/731) of KPC-2 KP isolates. Wzi typing could discriminate ST11 KP clones and precisely track their transmission. Conjugation assays demonstrated that Some KPC-2- and NDM-bearing plasmids could be conjugatively transferred. The transferability was influenced by different STs and different wzis. CRE patients were becoming increasingly younger due to nosocomial CRE acquisition. The average length of hospitalization of these patients showed a downward trend mainly due to significant increases in voluntarily discharged rates and mortality rates. No associations between the rates of antibiotics consumption and CRE prevalence were observed. Evidence-based measures could effectively reduce the prevalence of ST11-wzi209 clone but failed to control the dissemination of ST11-wzi141 KP clone. Conclusions Continued vigilance for the importations should be maintained. Coordinated regional interventions are urgently needed to reduce CRE threat.

scholarly journals Multiplex lateral flow immunochromatographic assay is an effective method to detect carbapenemases without risk of OXA-48-like cross reactivity

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Hadas Kon ◽  
Shirin Abramov ◽  
Sammy Frenk ◽  
David Schwartz ◽  
Ohad Shalom ◽  
...  
Keyword(s):  
Gold Standard ◽  
Clinical Microbiology ◽  
Cross Reactivity ◽  
Control Measures ◽  
Chain Reaction ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Highly Sensitive ◽  
Polymerase Chain ◽  
The Cross

Abstract Background It is essential to detect carriers of carbapenemase-producing Enterobacterales in order to implement infection control measures. The objectives of this study was to evaluate the NG-Test® CARBA 5 (CARBA 5) assay for detection of five carbapenemases and to assess the cross reactivity of other OXA-type carbapenemases with the OXA-48-like specific antibodies. Methods A total of 197 Enterobacterales isolates were tested. To evaluate the cross reactivity, 73 carbapenem-resistant A. baumannii, harboring OXA-type variants, were tested. Polymerase chain reaction (PCR) served as gold standard for carbapenemase identification. Results Excellent agreement was found between PCR and CARBA 5, for all but one isolate. The single false positive result (a blaSME positive S. marcescens isolate) was incorrectly positive for blaOXA-48 by CARBA 5. No cross reactivity was observed. The sensitivity and specificity were 100.0% and 98.0%, respectively. Conclusions The CARBA 5 assay is highly sensitive and specific and is recommended as a tool for the detection of the main carbapenemases of interest in clinical microbiology laboratories.

scholarly journals Infection Control for a Carbapenem-Resistant Enterobacteriaceae Outbreak in an Advanced Emergency Medical Services Center

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1537
Author(s):  
Yoshiro Sakai ◽  
Kenji Gotoh ◽  
Ryuichi Nakano ◽  
Jun Iwahashi ◽  
Miho Miura ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Service ◽  
Control Measures ◽  
Infection Control Team ◽  
Partial Closure ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Emergency Medical ◽  
Lactamase Gene ◽  
Carbapenem Resistant Enterobacteriaceae

Background: A carbapenem-resistant Enterobacteriaceae (CRE) outbreak occurred in an advanced emergency medical service center [hereafter referred to as the intensive care unit (ICU)] between 2016 and 2017. Aim: Our objective was to evaluate the infection control measures for CRE outbreaks. Methods: CRE strains were detected in 16 inpatients located at multiple sites. Environmental cultures were performed and CRE strains were detected in 3 of 38 sites tested. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and detection of β-lactamase genes were performed against 25 CRE strains. Findings: Molecular typing showed the PFGE patterns of two of four Klebsiella pneumoniae strains were closely related and the same MLST (ST2388), and four of five Enterobacter cloacae strains were closely related and same MLST (ST252). Twenty-three of 25 CRE strains harbored the IMP-1 β-lactamase gene and 15 of 23 CRE strains possessed IncFIIA replicon regions. Despite interventions by the infection control team, new inpatients with the CRE strain continued to appear. Therefore, the ICU was partially closed and the inpatients with CRE were isolated, and the ICU staff was divided into two groups between inpatients with CRE and non-CRE strains to avoid cross-contamination. Although the occurrence of new cases dissipated quickly after the partial closure, a few months were required to eradicate the CRE outbreak. Conclusion: Our data suggest that the various and combined measures that were used for infection control were essential in stopping this CRE outbreak. In particular, partial closure to isolate the ICU and division of the ICU staff were effective.

scholarly journals Increased Mortality Among Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Carriers Who Developed Clinical Isolates of Another Genotype

2019 ◽  
Vol 6 (2) ◽  
Author(s):  
Wen Kai Chen ◽  
Yong Yang ◽  
Ban Hock Tan
Keyword(s):  
Mortality Rate ◽  
Health Care Organizations ◽  
Fold Increase ◽  
Control Measures ◽  
Clinical Isolates ◽  
Adjusted Relative Risk ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Hospital Comparison ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Carbapenemase production by carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is encoded by a variety of genes on mobile genetic elements. Patients colonized by 1 genotype of CP-CRE may be subsequently infected by another genotype of CP-CRE. We sought to determine whether CP-CRE carriers who developed infection with another genotype had a higher mortality risk. Methods A retrospective cohort study was conducted using collected data from January 2012 to December 2016. Clinical isolates of CP-CRE were analyzed among the CP-CRE carriers who had developed an infection during their stay in the hospital. Comparison was made between CP-CRE carriers who developed clinical isolates of another genotype and those whose clinical isolates were of the same CP-CRE genotype that they were originally colonized with. The primary outcome analyzed was the 14-day mortality rate. Results A total of 73 CP-CRE carriers who had developed infection were analyzed. Ten (15.4%) of the carriers who developed an infection with clinical isolates of the same CP-CRE genotype died within 14 days, whereas 5 (62.5%) of those who developed an infection with clinical isolates of a different genotype died. This represented a 6-fold increase (adjusted relative risk, 6.36; 95% confidence interval, 1.75–23.06; P = .005) in the 14-day mortality rate. Conclusions CP-CRE carriers who developed clinical isolates of another genotype are at risk of increased mortality. This is a novel finding that is of interest to health care organizations worldwide, with profound implications for infection control measures, such as patient and staff cohorting.

Subsequent carbapenem-resistant Enterobacteriaceae (CRE)–associated infections among hospitalized patients with CRE colonization: Impact of antibiotic use and other factors

2020 ◽  
Vol 41 (9) ◽  
pp. 1084-1089
Author(s):  
Thana Khawcharoenporn ◽  
Wipada Laichuthai
Keyword(s):  
Infection Control ◽  
Antibiotic Use ◽  
Central Line ◽  
Control Measures ◽  
Factors Associated ◽  
Central Line Insertion ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Line Insertion ◽  
Carbapenem Resistant Enterobacteriaceae

AbstractWe demonstrated a 20% rate of subsequent carbapenem-resistant Enterobacteriaceae (CRE)–associated infections among hospitalized CRE carriers. Independent factors associated with the infections were number of colonization sites, central-line insertion, and receiving vancomycin before colonization. These findings underscore the importance of antibiotic stewardship and device-related infection control measures to prevent CRE infections.

scholarly journals Multiplex Lateral Flow Immunochromatographic Assay Is an Effective Method to Detect Carbapenemases Without Risk of OXA-48-like Cross Reactivity

2021 ◽  
Author(s):  
Hadas Kon ◽  
Shirin Abramov ◽  
Sammy Frenk ◽  
David Schwartz ◽  
Ohad Shalom ◽  
...  
Keyword(s):  
Gold Standard ◽  
Cross Reactivity ◽  
Control Measures ◽  
Chain Reaction ◽  
Specific Antibodies ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Highly Sensitive ◽  
Polymerase Chain ◽  
The Cross

Abstract Background: It is essential to detect carriers of carbapenemase-producing Enterobacterales in order to implement infection control measures. The objectives of this study was to evaluate the NG-Test® CARBA 5 (CARBA 5) assay for detection of five carbapenemases and to assess the cross reactivity of other OXA-type carbapenemases with the OXA-48-like specific antibodies. Methods: A total of 197 Enterobacterales isolates were tested. To evaluate the cross reactivity, 73 carbapenem-resistant A. baumannii, harboring OXA-type variants, were tested. Polymerase chain reaction (PCR) served as gold standard for carbapenemase identification. Results: Excellent agreement was found between PCR and CARBA 5, for all but one isolate. The single false positive result (a blaSME positive S. marcescens isolate) was incorrectly positive for blaOXA-48 by CARBA 5. No cross reactivity was observed. The sensitivity and specificity were 100.0% and 98.0%, respectively. Conclusions: The CARBA 5 assay is highly sensitive and specific and is recommended as a tool for the detection of five carbapenemases.

Predictors of Persistent Carbapenem-Resistant Enterobacteriaceae Carriage upon Readmission and Score Development

2016 ◽  
Vol 37 (2) ◽  
pp. 188-196 ◽  
Author(s):  
Pnina Ciobotaro ◽  
Natalie Flaks-Manov ◽  
Maly Oved ◽  
Ami Schattner ◽  
Moshe Hoshen ◽  
...  
Keyword(s):  
Risk Groups ◽  
Carrier State ◽  
Control Measures ◽  
Carrier Status ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
C Statistic ◽  
Cross Transmission ◽  
Validation Set ◽  
Carbapenem Resistant Enterobacteriaceae

BACKGROUNDCarriers of carbapenem-resistant Enterobacteriaceae (CRE) are often readmitted, exposing patients to CRE cross-transmission.OBJECTIVETo identify predictors of persistent CRE carriage upon readmission, directing a risk prediction score.DESIGNRetrospective cohort study.SETTINGUniversity-affiliated general hospital.PATIENTSA cohort of 168 CRE carriers with 474 readmissions.METHODSThe primary and secondary outcomes were CRE carriage status at readmission and length of CRE carriage. Predictors of persistent CRE carriage upon readmission were analyzed using a generalized estimating equations (GEE) multivariable model. Readmissions were randomly divided into derivation and validation sets. A CRE readmission score was derived to predict persistent CRE carriage in 3 risk groups: high, intermediate, and low. The discriminatory ability of the model and the score were expressed as C statistics.RESULTSCRE carrier status persisted for 1 year in 33% of CRE carriers. Positive CRE status was detected in 202 of 474 readmissions (42.6%). The following 4 variables were associated with persistent CRE carriage at readmission: readmission within 1 month (odds ratio [OR], 6.95; 95% confidence interval [CI], 2.79–17.30), positive CRE status on preceding admission (OR, 5.46; 95% CI, 3.06–9.75), low Norton score (OR, 3.07; 95% CI, 1.26–7.47), and diabetes mellitus (OR, 1.84; 95% CI, 0.98–3.44). The C statistics were 0.791 and 0.789 for the derivation set (n=322) model and score, respectively, and the C statistic was 0.861 for the validation set of the score (n=152). The rates of CRE carriage at readmissions (validation set) for the groups with low, intermediate, and high scores were 8.6%, 38.9%, and 77.6%, respectively.CONCLUSIONSCRE carrier state commonly persists upon readmission, and this risk can be estimated to guide screening policy and infection control measures.Infect. Control Hosp. Epidemiol. 2016;37(2):188–196

scholarly journals Seroprevalence of SARS-CoV-2 Antibodies Among Health Care Personnel at a Health Care System in Pakistan

2021 ◽  
pp. 101053952110110
Author(s):  
Salma Abbas ◽  
Aun Raza ◽  
Ayesha Iftikhar ◽  
Aamir Khan ◽  
Shahzaib Khan ◽  
...  
Keyword(s):  
Health Care ◽  
Control Measures ◽  
Health Care Personnel ◽  
Test Results ◽  
Antibody Testing ◽  
Chain Reaction ◽  
Past Infection ◽  
Infection Control Measures ◽  
History Of ◽  
Polymerase Chain

Health care personnel (HCP) are at high risk for coronavirus disease-2019 acquisition. Serum antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) indicate past infection. Our institution offered SARS-CoV-2 antibody testing to HCP. We surveyed HCP with positive test results to explore past exposure to SARS-CoV-2, details of symptoms during the preceding 6 months, and a history of SARS-CoV-2 polymerase chain reaction testing. A total of 2162 HCP underwent antibody testing. Eight hundred fifty-seven (39.6%) employees tested positive and, of these, 820 (95.7%) participated in the survey. When adjusted for age, males had higher odds of testing positive for SARS-CoV-2 antibodies compared with females (OR = 1.68; 95% CI = 1.37-2.05; P = .00) and clinical staff had higher odds of SARS-CoV-2 seropositivity compared with nonclinical staff (OR = 1.273; 95% CI = 1.06-1.53; P = .01). Implementation of effective infection control measures is essential to protect HCP from coronavirus disease-2019.

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

2021 ◽  
pp. 1-7
Author(s):  
Katharina R. Rynkiewich ◽  
Jinal Makhija ◽  
Mary Carl M. Froilan ◽  
Ellen C. Benson ◽  
Alice Han ◽  
...  
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Skilled Nursing ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Resident Care ◽  
Semistructured Interviews ◽  
Self Protection

Abstract Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

scholarly journals Duodenoscope-Associated Outbreak of a Carbapenem Resistant Enterobacteriaceae

2020 ◽  
Vol 41 (S1) ◽  
pp. s197-s197
Author(s):  
Sung Ran Kim ◽  
Joon Young Song ◽  
Min Hee Cho ◽  
Ji Yeon Song
Keyword(s):  
Gel Electrophoresis ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Analysis ◽  
Endoscopic Retrograde ◽  
Carbapenem Resistant ◽  
Case Control Analysis ◽  
Record Review ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Cleaning Protocol

Background: We describe and evaluate our outbreak of carbapenem-resistant K. pneumoniae transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: An outbreak investigation was performed when Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) were identified from bile specimens of 4 patients. The investigation included medical record review, practice audits, and surveillance cultures of duodenoscopes and environmental sites. If available, clinical specimens were obtained from patients who had undergone ERCP in the previous 3 months. Carbapenem-resistant Enterobacteriaceae (CRE) screening cultures were performed to identify additional patients until no CRE cases were detected during 2 consecutive weeks. Pulsed-field gel electrophoresis (PFGE) of KPC-KP isolates was implemented. Results: In total, 12 cases were identified with exposure to duodenoscope from February 2019 through April 2019, including 6 cases with infections and 6 asymptomatic carriers. Case-control analysis showed that 2 specific duodenoscopes would be associated with the KPC-KP outbreak. Duodenoscope reprocessing procedures did not deviate from manufacturer recommendations for reprocessing. After ethylene oxide (EO) gas sterilization, the outbreak was terminated. Conclusions: Meticulous cleaning protocol and enhanced surveillance are necessary to prevent outbreaks of CRE. Notably, enhanced cleaning measures, such as sterilization for duodenoscopes, would be required after procedures with KPC-KP carriers.Funding: NoneDisclosures: None

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