scholarly journals Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?

2020 ◽  
Vol 9 (9) ◽  
pp. 2744 ◽  
Author(s):  
Beatrice Tiri ◽  
Emanuela Sensi ◽  
Viola Marsiliani ◽  
Mizar Cantarini ◽  
Giulia Priante ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Prone Position ◽  
Antimicrobial Stewardship ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Prolonged Contact

The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.

scholarly journals Epidemiology and infection control of carbapenem resistant Acinetobacter baumannii and Klebsiella pneumoniae at a German university hospital: a retrospective study of 5 years (2015–2019)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Patrick Chhatwal ◽  
Ella Ebadi ◽  
Frank Schwab ◽  
Stefan Ziesing ◽  
Ralf-Peter Vonberg ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Hospital Stay ◽  
Acinetobacter Baumannii ◽  
Control Measures ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
History Of

Abstract Background Carbapenem resistant (CR) Klebsiella pneumoniae (Kp) and Acinetobacter baumannii (Ab) are emerging multidrug resistant bacteria with very limited treatment options in case of infection. Both are well-known causes of nosocomial infections and outbreaks in healthcare facilities. Methods A retrospective study was conducted to investigate the epidemiology of inpatients with CR Kp and CR Ab in a 1500-bed German university hospital from 2015 to 2019. We present our infection control concept including a weekly microbiologic screening for patients who shared the ward with a CR Kp or CR Ab index patient. Results Within 5 years, 141 CR Kp and 60 CR Ab cases were hospitalized corresponding to 118 unique patients (74 patients with CR Kp, 39 patients with CR Ab and 5 patients with both CR Ab and CR Kp). The mean incidence was 0.045 (CR Kp) and 0.019 (CR Ab) per 100 inpatient cases, respectively. Nosocomial acquisition occurred in 53 cases (37.6%) of the CR Kp group and in 12 cases (20.0%) of the CR Ab group. Clinical infection occurred in 24 cases (17.0%) of the CR Kp group and in 21 cases (35.0%) of the CR Ab group. 14 cases (9.9%) of the CR Kp group and 29 cases (48.3%) of the CR Ab group had a history of a hospital stay abroad within 12 months prior to admission to our hospital. The weekly microbiologic screening revealed 4 CR Kp cases caused by nosocomial transmission that would have been missed without repetitive screening. Conclusions CR Kp and CR Ab cases occurred infrequently. A history of a hospital stay abroad, particularly in the CR Ab group, warrants pre-emptive infection control measures. The weekly microbiologic screening needs further evaluation in terms of its efficiency.

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 Spread of Carbapenemase Producing Klebsiella pneumoniae Isolates in Our Hospital: Investigation of Molecular Typing and Clonal Relationship

2021 ◽  
Author(s):  
Reyhan Kiş ◽  
Ebru Demiray Gündüz ◽  
Ayşe Nur Sarı ◽  
Zeynep Gülay
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Hospital Staff ◽  
Control Measures ◽  
Automated System ◽  
Microbiology Laboratory ◽  
Clonal Relationship ◽  
Infection Control Measures ◽  
Carbapenem Resistant

Objective: Carbapenem resistance has been reported with increasing frequency among members of Enterobacterales, especially in the last 10 years. Screening and detection of carbapenemase-producing isolates is important in terms of both directing the treatment and preventing its spread. In our study, it was aimed to determine the carbapenemase types and molecular epidemiological relationships of carbapenem resistant Klebsiella pneumoniae isolates, which were isolated sequentially from the samples sent to microbiology laboratory of our hospital. Method: A total of 32 carbapenem-resistant K. pneumoniae isolates of the samples sent to microbiology laboratory between July and September 2014, were included in the study. In addition to classical methods, identification of isolates at species level was made with BD Phoenix ID/AST automated system. Carbapenemase types (blaOXA-48, blaNDM, blaIMP, blaKPC, blaVIM and blaGES) of the isolates were investigated by PCR. The clonal relationship between the isolates was assessed with PFGE. Results: It was noted that 18 isolates were obtained from intensive care units, 9 from inpatient and 5 from outpatient departments. The blaOXA48 gene was found in all isolates while the other carbapenemase genes were not found. It was determined that strains were isolated from 32 patients in our hospital had 12 different PFGE pulsotypes, named as A-L. Among these, the most common ones were B (n=18) and closely related B1 pattern (n=2). The remaining isolates were represented by 11 different types. It was observed that the first isolate with B pulsotype was responsible for the spread of the outbreak from General Intensive Care Unit. Conclusion: It has been thought that the spread of carbapenem- resistant K. pneumoniae isolates in the hospital was probably occurred through the transfer of isolates from patients with gastrointestinal colonization to other patients through hospital staff. Therefore, the spread of the isolates in hospitals can be limited by detecting colonization with active surveillance programs and by applying contact isolation and effective infection control measures.

The epidemiology, risk factors and outcomes of Carbapenem-resistant Klebsiella pneumoniae infections in the intensive care unit from 2012 to 2018

2020 ◽  
Author(s):  
Ping Wang ◽  
Xiaocui Zou ◽  
Boting Zhou ◽  
Tao Yin
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Control Measures ◽  
Icu Patients ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Incidence And Mortality ◽  
Changing Trend ◽  
Different Sources

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasing globally threat for human health, but the trends and clinical characteristics of CRKP infections in the intensive care unit(ICU) remain uninvestigated.Methods: A retrospective study was conducted among ICU patients infected with KP isolates from January 2012 to December 2018. Carbapenem resistant to Klebsiella pneumoniae was defined according to Clinical and Laboratory Standards Institute (CLSI) criteria. The incidence and changing trend of CRKP were determined. CRKP patient sources, specimen types, infection sources and outcomes were investigated. Results: There were 256(40.13%) patients with CRKP and 382(59.87%) patients with CSKP. The incidence of CRKP increased from 2012(11.11%) to 2017(63.48%) and decreased in 2018(51.52%). The proportion of isolates not susceptible to three carbapenems increased from 0 to 98.04%. The rates of CRKP isolated from blood, wound, urine and pleural fluid were higher than that of CSKP. CRKP infections were mainly ICU acquired, rather than input acquired. Conclusion: The incidence of CRKP was high in ICU, but showed a downward trend. Implementation of different infection control measures to different sources of patients, specimen types, and KP infections are necessary. Surveillance data will be needed for ICU patients to decrease the incidence and mortality of CRKP.

A National Intervention to Prevent the Spread of Carbapenem-Resistant Enterobacteriaceae in Israeli Post-Acute Care Hospitals

2014 ◽  
Vol 35 (7) ◽  
pp. 802-809 ◽  
Author(s):  
Debby Ben-David ◽  
Samira Masarwa ◽  
Amos Adler ◽  
Hagit Mishali ◽  
Yehuda Carmeli ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
Control Intervention ◽  
The Impact ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Post Acute Care

ObjectivePatients hospitalized in post-acute care hospitals (PACHs) constitute an important reservoir of antimicrobial-resistant bacteria. High carriage prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been observed among patients hospitalized in PACHs. The objective of the study is to describe the impact of a national infection control intervention on the prevalence of CRE in PACHs.DesignA prospective cohort interventional study.SettingThirteen PACHs in Israel.InterventionA multifaceted intervention was initiated between 2008 and 2011 as part of a national program involving all Israeli healthcare facilities. The intervention has included (1) periodic on-site assessments of infection control policies and resources, using a score comprised of 16 elements; (2) assessment of risk factors for CRE colonization; (3) development of national guidelines for CRE control in PACHs involving active surveillance and contact isolation of carriers; and (4) 3 cross-sectional surveys of rectal carriage of CRE that were conducted in representative wards.ResultsThe infection control score increased from 6.8 to 14.0 (P < .001) over the course of the study period. A total of 3,516 patients were screened in the 3 surveys. Prevalence of carriage among those not known to be carriers decreased from 12.1% to 7.9% (P = .008). Overall carrier prevalence decreased from 16.8% to 12.5% (P = .013). Availability of alcohol-based hand rub, appropriate use of gloves, and a policy of CRE surveillance at admission to the hospital were independently associated with lower new carrier prevalence.ConclusionA nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs.

scholarly journals 510. Exposure Investigation Following a Confirmed Case of Candida auris and Multiple Carbapenemase-Producing Carbapenem-Resistant Organisms

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S247-S247
Author(s):  
Frances Nicholson ◽  
Melanie Curless ◽  
Maggie Schiffhauer ◽  
Sean Zhang ◽  
Patricia Simner ◽  
...  
Keyword(s):  
Infection Control ◽  
Index Patient ◽  
The United States ◽  
Point Prevalence ◽  
Control Measures ◽  
Candida Auris ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Surveillance Cultures ◽  
Routine Surveillance

Abstract Background Co-infections of Candida auris and carbapenemase-producing carbapenem-resistant Gram-negative organisms (CP-CRO) are an increasing global concern and rarely seen in the United States. We report the case of a 59-year-old male, with recent hospitalization in India, admitted to our facility with C. auris isolated from urine and axilla/groin specimens and CP-CRO from five body sites. Methods Travel screening in the emergency department identified a patient at high risk for colonization/infection with multidrug-resistant organisms (MDRO). Contact precautions were initiated. Eight CP-CRO isolates were subsequently identified from clinical and routine surveillance cultures from five separate sites. Of the isolates, seven contained one or more carbapenemase-producing genes detected by Xpert Carba-R assay (Cepheid, Sunnyvale, CA) (Table 1). The microbiology laboratory alerted the infection control department of a presumptive positive C. auris from a clinical urine culture from the same patient. Enhanced mitigation strategies were initiated in regards to cleaning and disinfection. An exposure investigation was also conducted using a point prevalence approach. Surveillance cultures were obtained from inpatients currently admitted to the same unit as the index patient. Axilla/groin specimens were collected for C. auris testing, and rectal specimens were collected for CP-CRO gene testing (CRE Real-Time PCR). Results Eighteen patients in addition to the index patient were hospitalized on the acute medicine unit. One patient refused testing for CP-CRO; therefore, 17 patients were tested for CP-CRO, and 18 patients were tested for C. auris. Neither CP-CRO nor C. auris were recovered from any patient. Conclusion A patient co-infected with C. auris and multiple CP-CRO was identified by clinical and routine surveillance cultures at Johns Hopkins Hospital. Travel screening allowed proactive isolation upon presentation. Enhanced infection control measures were implemented and a point prevalence surveillance study was conducted on the general acute care medicine inpatient unit. No transmission of either C. auris or CP-CRO was detected, likely due in part to rapid identification and strict infection control measures. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of the Therapeutic Outcomes of Antibiotic Regimen Against Carbapenemase-Producing Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Clement Yaw Effah ◽  
Emmanuel Kwateng Drokow ◽  
Clement Agboyibor ◽  
Shaohua Liu ◽  
Emmanuel Nuamah ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Meta Analysis ◽  
Control Measures ◽  
Cochrane Library ◽  
Antibiotic Regimen ◽  
Success Rates ◽  
Infection Control Measures ◽  
Number Of Patients

Background: Carbapenemase-producing Klebsiella pneumoniae (CpKP) has been implicated as an increasing threat to public health. CpKP is a ubiquitous, opportunistic pathogen that causes both hospital and community acquired infections. This organism hydrolyzes carbapenems and other β-lactams and thus, leading to multiple resistance to these antibiotics. Despite the difficult to treat nature of infections caused by CpKP, little has been discussed on the mortality, clinical response and microbiological success rates associated with various antibiotic regimen against CpKP. This meta-analysis was designed to fill the paucity of information on the clinical impact of various antibiotic therapeutic regimens among patients infected with CpKP.Materials and Methods: Literature in most English databases such as Medline through PubMed, Google Scholar, Web of Science, Cochrane Library and EMBASE, were searched for most studies published between the years 2015–2020. Data were analyzed using the R studio 2.15.2 statistical software program (metaphor and meta Package, Version 2) by random-effects (DerSimonian and Laird) model.Results: Twenty-one (21) studies including 2841 patients who had been infected with CpKP were analysed. The overall mortality rate was 32.2% (95%CI = 26.23–38.87; I2 = 89%; p-value ≤ 0.01, Number of patients = 2716). Pooled clinical and microbiological success rates were 67.6% (95%CI = 58.35–75.64, I2 = 22%, p-value = 0.25, Number of patients = 171) and 74.9% (95%CI = 59.02–86.09, I2 = 53%, p-value = 0.05, Number of patients = 121), respectively. CpKP infected patients treated with combination therapy are less likely to die as compared to those treated with monotherapy (OR = 0.55, 95%CI = 0.35–0.87, p-value = 0.01, Number of patients = 1,475). No significant difference existed between the mortality rate among 60years and above patients vs below 60years (OR = 0.84, 95%CI = 0.28–2.57, p-value = 0.76, 6 studies, Number of patients = 1,688), and among patients treated with triple therapy vs. double therapy (OR = 0.50, 95%CI = 0.21–1.22, p-value = 0.13, 2 studies, Number of patients = 102). When compared with aminoglycoside-sparing therapies, aminoglycoside-containing therapies had positive significant outcomes on both mortality and microbiological success rates.Conclusion: New effective therapies are urgently needed to help fight infections caused by this organism. The effective use of various therapeutic options and the strict implementation of infection control measures are of utmost importance in order to prevent infections caused by CpKP. Strict national or international implementation of infection control measures and treatment guidelines will help improve healthcare, and equip governments and communities to respond to and prevent the spread of infectious diseases caused by CpKP.

scholarly journals Investigation of carbapenemase and mcr-1 genes in carbapenem-resistant Klebsiella pneumoniae isolates

2019 ◽  
Vol 13 (06) ◽  
pp. 504-509 ◽  
Author(s):  
Çiğdem Arabacı ◽  
Tuba Dal ◽  
Tuğcan Başyiğit ◽  
Neslihan Genişel ◽  
Rıza Durmaz
Keyword(s):  
Antibiotic Resistance ◽  
Klebsiella Pneumoniae ◽  
Bacterial Infections ◽  
Resistance Mechanisms ◽  
Control Measures ◽  
Epidemiological Methods ◽  
Infection Control Measures ◽  
Microdilution Method ◽  
Carbapenem Resistant ◽  
Susceptibility Tests

Introduction: Carbapenem-resistant Klebsiella pneumoniae are a major problem. We aimed to investigate carbapenemase-encoding genes and transferable mcr-1 genes among 57 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from hospitalized patients. Methodology: Antibiotic susceptibility tests were performed by Phoenix (BD). Results for ertapenem and colistin were confirmed by gradient diffusion and microdilution methods. Carbapenemase and mcr-1 genes were investigated by Polymerase Chain Reaction (PCR). Results: Thirty-two (56.14%) isolates were from intensive care units (ICU). Antibiotic resistance rates by Phoenix: 52.63% for amikacin; 73.69% trimethoprim sulfamethoxazole; 91.23% cefepime; 82.46% tigecycline; 59.65% colistin. Carbapenemases positivity: 82.45% (47) for blaOXA-48, 40.35% (23) blaOXA-55, 3.50% (2) blaOXA-51, 1.75% (1) blaOXA-23, 1.75% (1) blaOXA-24, 1.75% (1) blaIMP. blaOXA-58, blaKPC, blaNDM-1, and blaVIM were not detected. Twenty (35.08%) isolates had both blaOXA-48 and blaOXA-55. Three isolates were mcr-1 (+) and blaOXA-48 (+). One mcr-1 (+) isolates was blaOXA-51 (+). One colistin sensitive isolate determined by Phoenix, was found colistin resistant by microdilution. Conclusion: OXA-48 and OXA-55 co-harboring isolates and mcr-1 gene (+) isolates were spreading. Automated colistin susceptibility results should be confirmed by microdilution method. Resistance mechanisms in Enterobacteriaceae should be determined and the isolates should be monitored by molecular epidemiological methods. Effective infection control measures will contribute to reduce risk of antibiotic resistant bacterial infections and dissemination of antibiotic resistance.

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