Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control

Abboud, Cely Saad; Souza, E.E. de; Zandonadi, E.C.; Borges, Laryce Steffane de Carvalho; Miglioli, L.; Monaco, Fabrizio; Barbosa, Vera Lúcia; Cortez, Doralice; Bianco, Antonio C.; Braz, Andréa; Monteiro, Jussimara

doi:10.1016/j.jhin.2016.06.010

Cited by 21 publications

(19 citation statements)

References 15 publications

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“…Although international studies are well advanced in relation to the subject, especially in those aspects which concern the rapid genotypic laboratory detection of the microorganism in the hospital environment, the World Health Organization (WHO) affirms that there are still gaps in research that should be better investigated. In addition, data in Brazil are limited in relation to the epidemiological aspects of the blaKPC gene among enterobacteria (8)(9)(10)(11) .…”

Section: Introductionmentioning

confidence: 99%

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Alvim

Couto

Gazzinelli

2019

Rev. esc. enferm. USP

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Objective: To study the epidemiological profile of Healthcare-associated Infections caused by Enterobacteria which carry the Klebsiella pneumoniae Carbapenemase gene (blaKPC) in the hospital environment. Method: A descriptive study was conducted in a private hospital in Belo Horizonte, MG, Brazil, which included all patients with infections caused by Enterobacteriaceae which carry the Klebsiella pneumoniae Carbapenemase gene. The data were collected by the Automated System of Hospital Infection Control and analyzed by descriptive statistics by the Epi Info 7 program. Results: Eighty-two (82) patients participated in the study. Klebsiella pneumoniae was the most frequent species (68%) isolated in blood (30%), bronchoalveolar lavage (22%) and urine (18%), while catheter-associated bloodstream infection (30%) predominated regarding topography. A case fatality rate of 62% is highlighted in evaluating the outcome. Conclusion: The resistance genes spread rapidly, limiting the antimicrobial options for treating infectious diseases. The epidemiological profile of Healthcare-Associated Infections found in this study can be prevented by prevention and infection control programs.

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Section: Introductionmentioning

confidence: 99%

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Alvim

Couto

Gazzinelli

2019

Rev. esc. enferm. USP

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“…Of those that did, 2 observational cohort studies found that chlorhexidine bathing can reduce CRE colonization and potentially CRE infection. 16 , 19 …”

Section: Resultsmentioning

confidence: 99%

“…One review and several studies, including 2 large studies with more than 400,000 patients, found evidence that chlorhexidine bathing can reduce device-associated HAIs. 7 , 13 , 23 Specifically, Abboud et al’s 19 observational cohort study found chlorhexidine bathing reduced HAIs in CRE-colonized patients. Among ICU patients, 2 studies 11 , 23 found significant reductions in CLABSIs, although the reduction in MRSA-related BSIs in Huang et al 23 (2013) study was not statistically significant.…”

Section: Resultsmentioning

confidence: 99%

Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence

Gall

Long²,

Hall³

2020

J Patient Saf

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Objective The aim of the study was to summarize the latest evidence for patient bathing with a 2% to 4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection. Methods We searched 3 databases (CINAHL, MEDLINE, and Cochrane) for a combination of the key words “chlorhexidine bathing” and MeSH terms “cross-infection prevention,” “drug resistance, multiple, bacterial,” and “drug resistance, microbial.” Articles from January 1, 2008, to December 31, 2018, were included, as well as any key articles published after December 31. Results Our findings focused on health care–associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine bathing reduces MRSA acquisition and carriage, but not all studies found significant reductions in MRSA infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage, and one study showed lower VRE infections in the bathing group. Two studies found that bathing reduced CRE carriage (no studies examined CRE infections). Two very large studies (more than 140,000 total patients) found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already well controlled by other means. Conclusions There is a high level of evidence supporting chlorhexidine bathing to reduce MDRO acquisition; less evidence is available on reducing infections. Chlorhexidine bathing is low cost to implement, and adverse events are rare and resolve when chlorhexidine use is stopped. There is evidence of chlorhexidine resistance, but not at concentrations in typical use. Further research is needed on chlorhexidine bathing’s impact on outcomes, such as mortality and length of stay.

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“…La alta capacidad de difusión de genes blaKPC y su resistencia a los antibióticos, en particular, a los carbapenemas, exigió medidas preventivas para reducir el riesgo de transmisión de microorganismos en los servicios de salud. Es de destacar que los protocolos para la reducción de la presión selectiva deben aplicarse si se identifican los factores de riesgo para el desarrollo de microorganismos multirresistentes (4,5) .…”

Section: Introductionunclassified

“…La detección precoz de los factores de riesgo puede reducir la transmisión cruzada de microorganismos en el ambiente, así como la morbilidad y la mortalidad causadas por estos patógenos. Sin embargo, aún no hay consenso en la literatura acerca de qué factores de riesgo están asociados directamente a las IRAS causadas por Enterobacterias que llevan el gen KPC (4)(5)(6) . Por este motivo, el objetivo del presente estudio fue evaluar los factores de riesgo para Infecciones Relacionadas con la Asistencia Sanitaria causadas por Enterobacterias productoras de Klebsiella pneumoniae carbapenemase.…”

Section: Introductionunclassified

Risk factors for Healthcare-Associated Infections caused by KPC-producing Enterobacteriaceae: a case-control study

2020

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Objetivo: Evaluar los factores de riesgo para infecciones relacionadas con la asistencia sanitaria causadas por Enterobacteriaceae productoras de carbapenemas.Método: Este es un estudio retrospectivo de casos y controles que consistió en una muestra de 82 pacientes infectados y 164 controles, totalizando 246 pacientes. La recopilación de datos se realizó entre enero y mayo de 2017 mediante la búsqueda en el Sistema Automatizado de Control de Infecciones Hospitalarias y en los registros electrónicos de pacientes.Resultados: Pacientes previamente colonizados con microorganismos gramnegativos (OR: 10.7, 95% CI: 2-60, p=0.007), con cáncer (OR: 20.8, 95% CI: 4-120, p<0.001), utilizando una catéter de doble luz (OR: 30.5, 95% CI: 2-382, p=0.008), con lesión por presión (OR: 136.2, 95% CI: 11- 1623, p<0.001) y permanecer en la Unidad de Cuidados Intensivos (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) fueron más propensos a desarrollar infecciones causadas por Enterobacteriaceae productoras de carbapenemas que el grupo control. El área bajo la curva ROC mostró un buen rendimiento general (0,99; IC 95%: 0,992-0,998) del modelo de regresión logística final.Conclusión: La colonización previa, el cáncer, el uso de catéteres de doble luz, la lesión por presión y la estadía en la UCI fueron factores de riesgo muy importantes para la adquisición de infecciones en el entorno hospitalario. Objective: To evaluate the risk factors for healthcare-associated infections caused by Klebsiella pneumoniae carbapenemase producing Enterobacteriaceae. Method: This is a retrospective case-control study that consisted of a sample of 82 infected patients and 164 controls, totaling 246 patients. Data collection was performed between January and May 2017 through search in the Automated Hospital Infection Control System and in the electronic patient records.Results: Patients previously colonized with gram-negative microorganisms (OR: 10.7, 95% CI: 2-60, p=0.007), with cancer (OR: 20.8, 95% CI: 4-120, p<0.001), using a double lumen catheter (OR: 30.5, 95% CI: 2-382, p=0.008), with pressure injury (OR: 136.2, 95% CI: 11- 1623, p<0.001) and Intensive Care Unit stay (OR: 1.4, 95% CI: 1.2-1.6, p <0.001) had a greater chance of developing Healthcare-associated Infections caused by KPC-producing Enterobacteriaceae than the control group. The area under the ROC curve showed a good overall performance (0.99, 95% CI: 0.992-0.998) of the final logistic regression model. Conclusion: Previous colonization, cancer, double lumen catheter use, pressure injury and ICU stay were very important risk factors for the acquisition of infections in the hospital environment.

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Carbapenem-resistant Enterobacteriaceae on a cardiac surgery intensive care unit: successful measures for infection control

Cited by 21 publications

References 15 publications

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Chlorhexidine Bathing Strategies for Multidrug-Resistant Organisms: A Summary of Recent Evidence

Risk factors for Healthcare-Associated Infections caused by KPC-producing Enterobacteriaceae: a case-control study

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