A Multifaceted Intervention Strategy for Eradication of a Hospital-Wide Outbreak Caused by Carbapenem-Resistant <i>Klebsiella pneumoniae</i> in Southern Israel

Borer, Abraham; Eskira, Seada; Nativ, Ronit; Saidel-Odes, Lisa; Riesenberg, Klaris; Livshiz–Riven, Ilana; Schlaeffer, Francisc; Sherf, Michael; Peled, Nechama

doi:10.1086/662620

Cited by 58 publications

(69 citation statements)

References 13 publications

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“…Dedicated nursing staff is probably one of the most relevant measure to avoid cross transmission [15,[17][18][19]. In the context of an epidemic, cohorting patients with dedicated nursing staff in three different groups (cases, contacts and newly admitted patients) was shown to be effective in controlling the outbreak [6,11,17]. The present study shows that dedicating staff to an index case carrying CPE also prevents the occurrence of outbreaks.…”

Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 49%

“…A specific early warning system organised by the French Health authorities at the national level to systematically collect information on CPE cases, reported 113 cases in 2011 for the whole country [13]. Bundle measures similar to those described in the present study have been associated with the limitation of CPE spread in Israel where CPE are endemic [15][16][17].…”

Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 63%

“…Interestingly, as already reported by others [16], rapidly isolating index patients with barrier precautions was not always sufficient to avoid secondary cases and these occurred in six of 55 events (Table 2). Dedicated nursing staff is probably one of the most relevant measure to avoid cross transmission [15,[17][18][19]. In the context of an epidemic, cohorting patients with dedicated nursing staff in three different groups (cases, contacts and newly admitted patients) was shown to be effective in controlling the outbreak [6,11,17].…”

Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 99%

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Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

et al. 2014

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In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate, and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140 CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10% (13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32) to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and strength of the measures implemented around the CPE index case: quick (within two days of patient admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an emerging stage.

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Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 49%

Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 63%

Section: Number Of Events Proportion Of Outbreaks Among Eventsmentioning

confidence: 99%

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Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

et al. 2014

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“…One study found that healthy patients who tested positive for carbapenem-resistant A. baumannii cultures had 8.4 times the risk of developing a subsequent infection than patients who remained negative on surveillance cultures (15 ). In another study, 32 of 433 patients (7.4%) with carbapenem-resistant K. pneumoniae developed an infection within 2-40 days from colonization to infection (16 ).…”

Section: Discussionmentioning

confidence: 99%

Analytical Performance of Multiplexed Screening Test for 10 Antibiotic Resistance Genes from Perianal Swab Samples

et al. 2016

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BACKGROUND Multiantibiotic-resistant bacteria pose a threat to patients and place an economic burden on health care systems. Carbapenem-resistant bacilli and extended-spectrum β-lactamase (ESBL) producers drive the need to screen infected and colonized patients for patient management and infection control. METHODS We describe a multiplex microfluidic PCR test for perianal swab samples (Acuitas® MDRO Gene Test, OpGen) that detects the vancomycin-resistance gene vanA plus hundreds of gene subtypes from the carbapenemase and ESBL families Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-β-lactamase (NDM), Verona integron-mediated metallo-β-lactamase (VIM), imipenemase metallo-β-lactamase (IMP), OXA-23, OXA-48, OXA-51, CTX-M-1, and CTX-M-2, regardless of the bacterial species harboring the antibiotic resistance. RESULTS Analytical test sensitivity per perianal swab is 11–250 CFU of bacteria harboring the antibiotic resistance genes. Test throughput is 182 samples per test run (1820 antibiotic resistance gene family results). We demonstrate reproducible test performance and 100% gene specificity for 265 clinical bacterial organisms harboring a variety of antibiotic resistance genes. CONCLUSIONS The Acuitas MDRO Gene Test is a sensitive, specific, and high-throughput test to screen colonized patients and diagnose infections for several antibiotic resistance genes directly from perianal swab samples, regardless of the bacterial species harboring the resistance genes.

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“…It has, in fact, been proposed that, given the ease of transfer and acquisition of these genes, outbreaks must be controlled early on in order to avoid hospital dissemination (3,6,12). Indeed, surveys in regions of endemicity, such as Israel, Italy, and the northeastern United States, have reported successful control management of infections caused by KPC producers (1,2,4,8,17,26). In the present prospective study, we documented the effectiveness of containment strategies in combating the secondary transmission of imported KPC clones from other Greek tertiarycare facilities.…”

Section: Discussionmentioning

confidence: 99%

Imported Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Clones in a Greek Hospital: Impact of Infection Control Measures for Restraining Their Dissemination

et al. 2012

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The recent emergence of carbapenemase-producing Enterobacteriaceae strains represents a major threat for hospitalized patients. We document the dissemination and control of carbapenemase-producing Klebsiella pneumoniae clones in a Greek hospital. During a 3-year study period (January 2009 to December 2011), carbapenemase-producing K. pneumoniae strains were isolated from clinical samples from 73 individual patients. Phenotyping and molecular testing confirmed that 52 patients were infected with K. pneumoniae carbapenemase 2 (KPC-2) producers, 12 were infected with VIM-1 producers, and the remaining 9 were infected with isolates producing both KPC-2 and VIM-1 enzymes. Twenty-eight of these clinical cases were characterized as imported health care associated, and 23 of these were attributed to KPC producers and 5 were attributed to KPC and VIM producers. The remaining 45 cases were deemed hospital acquired. In the second year of the study, intensified infection control intervention was implemented, followed by active surveillance and carrier isolation in the third year. The incidence of carbapenemase-producing K. pneumoniae patient cases decreased from 0.52/1,000 patient days in 2009 to 0.32/1,000 patient days in 2010 (P ‫؍‬ 0.075). Following these additional infection control measures, the incidence fell to 0.21/1,000 patient days in 2011 and differed significantly from that in 2009 (P ‫؍‬ 0.0028). Despite the fact that the imported cases of carbapenemase-producing K. pneumoniae were equally distributed over this 3-year period, the incidence of hospital-acquired cases decreased from 0.36/1,000 patient days in 2009 to 0.19/1,000 patient days in 2010 (P ‫؍‬ 0.058) and to 0.1/1,000 patient days in 2011 (P ‫؍‬ 0.0012). Our findings suggest that rigorous infection control measures and active surveillance can effectively reduce the incidence of secondary transmission due to KPC-producing pathogens.

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A Multifaceted Intervention Strategy for Eradication of a Hospital-Wide Outbreak Caused by Carbapenem-Resistant Klebsiella pneumoniae in Southern Israel

Abstract: This intervention produced an enormous impact on patient location, surveillance cultures, and antibiotic policies and a massive investment in infection control resources.

Cited by 58 publications

References 13 publications

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

Analytical Performance of Multiplexed Screening Test for 10 Antibiotic Resistance Genes from Perianal Swab Samples

Imported Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae Clones in a Greek Hospital: Impact of Infection Control Measures for Restraining Their Dissemination

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