Active surveillance at the time of hospital admission for multidrug-resistant microorganisms among patients who had recently been hospitalized at health care facilities

Yoon, Young Kyung; Ryu, Jee Myung; Lee, Min Jung; Lee, Sung Eun; Yang, Kyung Sook; Lee, Chang Kyu

doi:10.1016/j.ajic.2019.04.008

Cited by 6 publications

(4 citation statements)

References 38 publications

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“…Until such uncertainties are addressed, infection prevention and control measures are essential to reduce the spread of MDR-GNB. These include, but are not limited to: (a) compliance with standard and contact precautions [36,37] (i.e., hand hygiene and appropriate use of gloves and gowns); (b) active microbiological surveillance [38]; (c) reduction in device use to prevent catheter-associated infection and ventilator-associated pneumonia [39]; (d) adequate cleaning and disinfection of environmental surfaces [40] and reusable devices [41], especially duodenoscopes [42]; (e) antimicrobial stewardship, with particular emphasis on surgical antimicrobial prophylaxis [43]; and (f) selective digestive decontamination [44], with promising results that should, however, be interpreted with caution [45]. This will not be an easy endeavour, as the challenges to tackling antimicrobial resistance will be unprecedented in the aftermath of the COVID-19 pandemic, due to changes in antimicrobial usage and availability [46].…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Fernández-Martínez

Cárcel-Fernández

Fuente-Martos

et al. 2022

IJERPH

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Multidrug-resistant Gram-negative bacteria (MDR-GNB) are microorganisms that have acquired resistance to extended-spectrum antibacterials and constitute an emerging threat to public health. Although carriers are an important source of transmission in healthcare settings, data about risk factors for MDR-GNB carriage are limited. Therefore, we aimed to identify risk factors for MDR-GNB carriage upon intensive care unit (ICU) admission and to optimise screening strategies. We conducted a case–control study. Admissions of adult patients to the ICU of a 1000-bed hospital during a year were included. We collected sociodemographic, clinical and microbiological data and performed a multivariate logistic regression model. A total of 1342 patients resulted in 1476 episodes of ICU admission, 91 (6.2%) of whom harboured MDR-GNB (38.5% women; median age 63.9 years). The most frequently isolated pathogens were Escherichia coli (57%) and Klebsiella pneumoniae (16%). The most frequent resistance mechanism was production of extended-spectrum beta lactamases. MDR-GNB carriage was associated to liver cirrhosis (OR 6.54, 95% CI 2.17–19.17), previous MDR-GNB carriage (OR 5.34, 1.55–16.60), digestive surgery (OR 2.83, 1.29–5.89) and length of hospital stay (OR 1.01 per day, 1.00–1.03). Several risk factors for MDR-GNB carriage upon admission to a high-risk setting were identified; the main comorbidity was liver cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Fernández-Martínez

Cárcel-Fernández

Fuente-Martos

et al. 2022

IJERPH

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“…High VRE endemicity has become stabilized in our ICU settings despite weekly active surveillance for rectal VRE and other infection control measures. However, our hospital has been faced with a constant influx of patients colonized with MDROs from outside healthcare facilities since 2016, when it was designated a regional emergency center [ 13 , 26 ]. Therefore, the infection control staff developed a daily CHG bathing protocol to overcome the challenges of priority VRE control.…”

Section: Discussionmentioning

confidence: 99%

Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study

Suh

Kim

Lee

et al. 2021

Antimicrob Resist Infect Control

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Background Critically ill patients in intensive care units (ICUs) often acquire opportunistic infections or are colonized by vancomycin-resistant enterococci (VRE), which limits therapeutic options and results in high case-fatality rates. In clinical practice, the beneficial effects of universal chlorhexidine gluconate (CHG) bathing on the control of VRE remain unclear. This study aimed to investigate whether 2% CHG daily bathing reduced the acquisition of VRE in the setting of a medical ICU (MICU) with VRE endemicity. Methods This quasi-experimental intervention study was conducted in a 23-bed MICU of a tertiary care hospital in Korea from September 2016 to December 2017. In a prospective, interrupted time-series analysis (ITS) with a 6-month CHG bathing intervention, we compared the acquisition and incidence of VRE and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Acinetobacter baumannii (CRAB) between the pre-intervention and intervention periods. The primary and secondary outcomes were a change in the acquisition of VRE and incidence of VRE, MRSA, or CRAB between the two periods, respectively. Results All the adult patients admitted to the MICU were enrolled in the pre-intervention (n = 259) and intervention (n = 242). The overall CHG daily bathing compliance rate was 72.5%. In the ITS, there was a significant intervention effect with a 58% decrease in VRE acquisition (95% CI 7.1–82.1%, p = 0.038) following the intervention. However, there was no significant intervention effects on the incidence trend of VRE, MRSA, and CRAB determined by clinical culture between the pre-intervention and intervention periods. Conclusion In this real-world study, we concluded that daily bathing with CHG may be an effective measure to reduce VRE cross-transmission among patients in MICU with a high VRE endemicity.

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“…Screening and prophylactic isolation: Patients in the ICU are particularly vulnerable to colonization or infection with MDRO either upon admission or during their hospital stay due to various risk factors. To reduce the spread of MDRO, it is crucial to implement proactive screening or isolate patients with high-risk factors ( 100 ). Although proactive testing methods differ among hospitals in different regions, they usually involve obtaining fecal/rectal swabs from patients upon admission or at regular intervals (weekly or bi-weekly).…”

Section: Control Strategies Of Cr-gnbmentioning

confidence: 99%

Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention – a comprehensive review

Li,

Zhou,

Yang

et al. 2024

Front. Public Health

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Intensive care units (ICUs) are specialized environments dedicated to the management of critically ill patients, who are particularly susceptible to drug-resistant bacteria. Among these, carbapenem-resistant Gram-negative bacteria (CR-GNB) pose a significant threat endangering the lives of ICU patients. Carbapenemase production is a key resistance mechanism in CR-GNB, with the transfer of resistance genes contributing to the extensive emergence of antimicrobial resistance (AMR). CR-GNB infections are widespread in ICUs, highlighting an urgent need for prevention and control measures to reduce mortality rates associated with CR-GNB transmission or infection. This review provides an overview of key aspects surrounding CR-GNB within ICUs. We examine the mechanisms of bacterial drug resistance, the resistance genes that frequently occur with CR-GNB infections in ICU, and the therapeutic options against carbapenemase genotypes. Additionally, we highlight crucial preventive measures to impede the transmission and spread of CR-GNB within ICUs, along with reviewing the advances made in the field of clinical predictive modeling research, which hold excellent potential for practical application.

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Active surveillance at the time of hospital admission for multidrug-resistant microorganisms among patients who had recently been hospitalized at health care facilities

Cited by 6 publications

References 38 publications

Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit

Real-world experience of how chlorhexidine bathing affects the acquisition and incidence of vancomycin-resistant enterococci (VRE) in a medical intensive care unit with VRE endemicity: a prospective interrupted time-series study

Carbapenem-resistant Gram-negative bacteria (CR-GNB) in ICUs: resistance genes, therapeutics, and prevention – a comprehensive review

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