Containment of a Country-wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Israeli Hospitals via a Nationally Implemented Intervention

Schwaber, Mitchell J.; Lev, Baruch; Israeli, Avi; Solter, Ester; Smollan, Gill; Rubinovitch, Bina; Shalit, Itamar; Carmeli, Yehuda

doi:10.1093/cid/cir025

Cited by 396 publications

(378 citation statements)

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“…CPE have been implicated in hospital outbreaks and have the propensity to spread (or disseminate their plasmids) rapidly at local, regional, and international levels. [10][11][12][13][14][15] We provide comprehensive survey results on the occurrence of carbapenemase-producing K pneumoniae and E coli between Nov, 2013, and April, 2014, from 455 hospitals in 34 European countries plus Turkey and Israel, together serving more than 270 million citizens out of a total population of 600 million. During the course of this investigation, NELs successfully expanded their capacity and adjusted workfl ows to accommodate new diagnostic tests.…”

Section: Discussionmentioning

confidence: 99%

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Grundmann¹,

Glasner²,

Albiger³

et al. 2017

The Lancet Infectious Diseases

544

365

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SummaryBackground Gaps in the diagnostic capacity and heterogeneity of national surveillance and reporting standards in Europe make it diffi cult to contain carbapenemase-producing Enterobacteriaceae. We report the development of a consistent sampling framework and the results of the fi rst structured survey on the occurrence of carbapenemaseproducing Klebsiella pneumoniae and Escherichia coli in European hospitals.

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Section: Discussionmentioning

confidence: 99%

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Grundmann¹,

Glasner²,

Albiger³

et al. 2017

The Lancet Infectious Diseases

544

365

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“…Corrado Girmenia, 1 Claudio Viscoli, 2 Alfonso Piciocchi, 3 Laura Cudillo, 4 Stefano Botti, 5 Antonio Errico, 6 Loredana Sarmati, 7 Fabio Ciceri, 8 Franco Locatelli, 9 Maddalena Giannella, 10 Matteo Bassetti, 11 Carlo Tascini, 12 Letizia Lombardini, 6,13 Ignazio Majolino, 14 Claudio Farina, 15 Francesco Luzzaro, 16 Gian Maria Rossolini, [17][18][19] and …”

Section: F E R R a T A S T O R T I F O U N D A T I O Nunclassified

Management of carbapenem resistant Klebsiella pneumoniae infections in stem cell transplant recipients: an Italian multidisciplinary consensus statement

et al. 2015

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The increasing incidence of infections by carbapenemresistant enterobacteria (CRE), in particular carbapenemresistant Klebsiella pneumoniae (CRKp), is a significant public health challenge worldwide.1 The interim results of the last European survey on CRE (EuSCAPE project 2013) indicate that CRKp is endemic in Italy, and that this endemicity is mostly contributed to by strains producing KPC-type carbapenemases.CRKp infections are associated with high morbidity and mortality rates, particularly among Intensive Care Units (ICU) patients, recipients of solid organ transplants (SOT) and patients with hematological malignancies. 1-3The Gruppo Italiano Trapianto Midollo Osseo (GITMO) recently performed a retrospective study (2010)(2011)(2012)(2013) which involved 52 stem cell transplant (SCT) centers to assess the epidemiology and the prognostic factors of CRKp infections in autologous and allogeneic SCT.4 Cases of CRKp infection were reported in 53.4% of the centers and were documented in 0.4% of autologous and 2% of allogeneic SCTs. A CRKp colonization was followed by an infection in about 30% of cases. The infection-related mortality rate was 16% in autologous and 64.4% in allogeneic SCT. A pre-transplant CRKp infection and inadequate first-line treatment were independent factors associated with an increase in mortality in allogeneic SCT patients who developed a CRKp infection. Indeed, despite the administration of a first-line CRKp-targeted antibiotic therapy (CTAT) (see below), 55% of patients who received a CTAT still died. These data underscored the challenge regarding CRKp infections, particularly in the allogeneic-SCT setting, in terms of outcome and management of post-transplant complications, and also raised an issue about the eligibility for transplant among patients who got colonized or had developed a CRKp infection before transplant.Based on these original data and on the recent literature, a multidisciplinary group of experts from GITMO, the Italian Association of Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI), the Italian Society of Infectious and Tropical Diseases (Società Italiana Malattie Infettive e Tropicali; SIMIT), and the Italian National Transplant Center (Centro Nazionale Trapianti; CNT) was convened with the aim of providing consensus recommendations for the management of CRKp infection/colonization in autologous and allogeneic-SCT recipients.The Expert Panel (EP) included 17 specialists in hematology, infectious diseases, clinical microbiology and nursing, who were selected by virtue of their expertise in research and clinical practice of infections in SCT. The areas of major concern were defined by generating clinical key issues using the criterion of clinical relevance, i.e. impact on patient management and risk of inappropriateness, and recommendations were obtained according to a nominal group technique.The EP focused its discussion on four key-issues considered relevant for the present recommendations that are shown in Table 1.Detection of CRKp carriers b...

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“…6 Israel experienced a large outbreak beginning in 2006, and efforts to contain this outbreak are continuing. 7,8 Data concerning the epidemiology of CP-CRE remain limited. Several case-control studies have identified healthcare-associated factors as predictors for isolation of CP-CRE among hospitalized patients.…”

mentioning

confidence: 99%

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

Schwartz-Neiderman

Braun

Fallach

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient.methods. A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient. Cases were defined as positive tests for CP-CRE. For each case patient, 2 matched controls were randomly selected from the pool of contacts who tested negative for CP-CRE following exposure to the same index case. Bivariate and multivariate analyses were conducted using conditional logistic regression.results. In total, 53 positive contacts were identified in 40 unique investigations (896 tests performed on 735 contacts) between October 6, 2008, and June 7, 2012. bla KPC was the only carbapenemase identified. In multivariate analysis, risk factors for CP-CRE acquisition among contacts were (1) contact with an index patient for ≥3 days (odds ratio [OR], 9.8; 95% confidence interval [CI], 2.0-48.9), (2) mechanical ventilation (OR, 4.1; 95% CI, 1.4-11.9), and (3) carriage or infection with another multidrug-resistant organism (MDRO; OR, 2.6; 95% CI, 1.0-7.1). Among patients who received antibiotics, cephalosporins were associated with a lower risk of acquisition.conclusions. Patient characteristics (ventilation and carriage of another MDRO) as well as duration of contact are risk factors for CP-CRE acquisition among contacts. The role of cephalosporins requires further study.

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Containment of a Country-wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Israeli Hospitals via a Nationally Implemented Intervention

Abstract: A centrally coordinated intervention succeeded in containing a nationwide CRE outbreak after local measures failed. The intervention demonstrates the importance of strategic planning and national oversight in combating antimicrobial resistance.

Cited by 396 publications

References 35 publications

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study

Management of carbapenem resistant Klebsiella pneumoniae infections in stem cell transplant recipients: an Italian multidisciplinary consensus statement

Risk Factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) Acquisition Among Contacts of Newly Diagnosed CP-CRE Patients

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