An effective intervention to limit the spread of an epidemic carbapenem-resistant  Klebsiella pneumoniae  strain in an acute care setting: From theory to practice

Ciobotaro, Pnina; Oved, Maly; Nadir, Erez; Bardenstein, Rita; Zimhony, Oren

doi:10.1016/j.ajic.2011.05.004

Cited by 59 publications

(69 citation statements)

References 17 publications

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“…Initially, CPE appeared to cause hospital-acquired infections, mainly in ICU patients (28,29,67,233,265). More recently, however, they have spread in different health care settings, including long-term care facilities (LTCF) (16,53,83,161,249).…”

Section: Cpe In Health Care Settings Epidemiologymentioning

confidence: 99%

“…Thus, every clinical microbiology laboratory should establish a reliable detection methodology. Additionally, resources and trained personnel should be readily available to carry out point prevalence surveys as well as active surveillance cultures, a demanding yet highly effective approach for detecting carriers (15,53,177). The most suitable anatomic sites for surveillance cultures appear to be the perianal area and the rectum (31,261).…”

Section: Tracing Of Carriersmentioning

confidence: 99%

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Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

et al. 2012

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SUMMARY The spread of Enterobacteriaceae , primarily Klebsiella pneumoniae , producing KPC, VIM, IMP, and NDM carbapenemases, is causing an unprecedented public health crisis. Carbapenemase-producing enterobacteria (CPE) infect mainly hospitalized patients but also have been spreading in long-term care facilities. Given their multidrug resistance, therapeutic options are limited and, as discussed here, should be reevaluated and optimized. Based on susceptibility data, colistin and tigecycline are commonly used to treat CPE infections. Nevertheless, a review of the literature revealed high failure rates in cases of monotherapy with these drugs, whilst monotherapy with either a carbapenem or an aminoglycoside appeared to be more effective. Combination therapies not including carbapenems were comparable to aminoglycoside and carbapenem monotherapies. Higher success rates have been achieved with carbapenem-containing combinations. Pharmacodynamic simulations and experimental infections indicate that modification of the current patterns of carbapenem use against CPE warrants further attention. Epidemiological data, though fragmentary in many countries, indicate CPE foci and transmission routes, to some extent, whilst also underlining the lack of international collaborative systems that could react promptly and effectively. Fortunately, there are sound studies showing successful containment of CPE by bundles of measures, among which the most important are active surveillance cultures, separation of carriers, and assignment of dedicated nursing staff.

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Section: Cpe In Health Care Settings Epidemiologymentioning

confidence: 99%

Section: Tracing Of Carriersmentioning

confidence: 99%

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

et al. 2012

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“…However, several studies show low adherence to such strategy. (8)(9)(10) Besides, there is the risk of delay in the diagnosis of colonization or infection, which increases the possibilities of transmission among patients.…”

Section: Introductionmentioning

confidence: 99%

Infecção ou colonização por micro-organismos resistentes: identificação de preditores

et al. 2013

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Objective: Identifying predictors of infection or colonization with resistant microorganisms. Methods: A quantitative study of prospective cohort was carried out. A descriptive analysis was performed in order to know the population of the study and a discriminant analysis was performed to identify the predictors. Results: In this study were included 85 patients with infections caused by resistant microorganisms: carbapenem-resistant Pseudomonas aeruginosas (24.7%); carbapenem-resistant Acinetobacter (21.2%); methicillin-resistant Staphylococcus aureus (25.9%), vancomycin-resistant Enterococcus spp (17.6%) and carbapenem-resistant Klebsiella pneumonia (10.6%). The discriminant analysis identified transfers from other hospitals and hospitalization in intensive care unit as predictors for the occurrence of infections by the following groups: S. aureus resistant to methicillin, Acinetobacter resistant to carbapenems and K. pneumoniae resistant to carbapenems. None of the studied variables was discriminant for vancomycin-resistant Enterococcus spp. and carbapenem-resistant P. aeruginosas. Conclusion: The predictors found were: ICU hospitalization and transfers from other hospitals. ResumoObjetivo: Identificar os fatores preditores de infecção ou colonização por micro-organismos resistentes. Métodos: Foi realizado estudo quantitativo de coorte prospectivo. Foram realizadas a análise descritiva, para conhecimento da população do estudo, e a análise discriminante, para identificação dos fatores preditores. Resultados: Foram incluídos 85 pacientes com infecções por micro-organismos resistentes: Pseudomonas aeruginosas resistente aos carbapenêmicos (24,7%), Acinetobacter resistente aos carbapenêmicos (21,2%), Staphylococcus aureus resistente à meticilina (25,9%), Enterococcus spp. resistente à vancomicina (17,6%) e Klebsiella pneumoniae resistente aos carbapenêmicos (10,6%). A análise discriminante identificou transferências de outros hospitais e internação na Unidade de Terapia Intensiva como fatores preditores para ocorrência de infecção pelos grupos S. aureus resistente à meticilina, Acinetobacter resistente aos carbapenêmicos e K. pneumoniae resistente aos carbapenêmicos. Nenhuma das variáveis estudadas foi discriminante para Enterococcus spp. resistente à vancomicina e P. aeruginosas resistente aos carbapenêmico. Conclusão: Os fatores preditores encontrados foram: internação na UTI e a transferências de outros hospitais.

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“…More specifically, compliance improved from 22 to 43% in hospital wards while it improved from 27 to 56% in the ICU. In addition, our observations reinforce the necessity of employing rectal surveillance cultures in order to restrain the dissemination of KPC-producing clones (2,5,8,10,15). Although rectal swab screening of all of our new ICU admissions was not implemented, this practice was found to be very useful, since it made possible the early recognition of KPC clonal strains likely to be introduced into our hospital, especially in the cases of patients with previous hospitalizations.…”

Section: Discussionmentioning

confidence: 88%

“…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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An effective intervention to limit the spread of an epidemic carbapenem-resistant Klebsiella pneumoniae strain in an acute care setting: From theory to practice

Cited by 59 publications

References 17 publications

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions

Infecção ou colonização por micro-organismos resistentes: identificação de preditores

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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