Effects of screening strategies to detect carbapenem-resistant gram-negative bacteria: A systematic review

Verdugo-Paiva, Francisca; Otaíza, Fernando; Rosón-Rodriguez, Pablo; Rojas-Gómez, Ana María; Galas, Marcelo; Omeiri, Nathalie El; Fuentes, Yackelin; Rada, Gabriel; Ramón-Pardo, Pilar

doi:10.1016/j.ajic.2022.02.018

Cited by 10 publications

(7 citation statements)

References 33 publications

(230 reference statements)

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“…As the epidemic studies report successful containment of the outbreaks in four out of five outbreaks, it remains unknown whether these components were not reported or actually not performed. Our results are in addition to a recently published systematic review by Verdugo-Paiva et al [ 15 ], which reported mostly screening of high-risk patients for carbapenem-resistant Gram-negatives in the endemic as well as the epidemic setting, whereas screening of contact patients was only described in less than half of the studies. In addition, the definition of contact patients was often vague in these studies, ranging from roommates to ward mates and to hospitalized at the same time in the whole hospital or admitted at the same time.…”

Section: Discussionsupporting

confidence: 71%

“…However, the guidelines do not give any recommendation regarding OI in either endemic or epidemic situations (Additional file 1 : Table S1) but instead, specifically mention that there is no consensus on the role of screening to identify carriers. However, various screening strategies are used for carbapenem-resistant Gram-negatives, mostly in outbreak settings, as recently presented by Verdugo-Paiva et al [ 15 ]. In addition, the guidelines recommend environmental cleaning and disinfection, nevertheless, no recommendation is made regarding screening of the environment to identify potential sources.…”

Section: Introductionmentioning

confidence: 99%

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Outbreak investigations after identifying carbapenem-resistant Pseudomonas aeruginosa: a systematic review

Büchler

Shahab

Severin

et al. 2023

Antimicrob Resist Infect Control

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Background Carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a serious cause of healthcare-associated infections. Part of the infection prevention and control measures are outbreak investigations (OI) of patients, healthcare workers (HCW), and the environment after identifying a CRPA in order to identify carriers and environmental reservoirs, so that targeted actions can be taken to prevent further transmission. However, little is known on when and how to perform such OI. Therefore, this systematic review aims to summarize OI performed after detection of CRPA in the endemic and epidemic hospital setting. Main text Articles related to our research question were identified through a literature research in multiple databases (Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar) until January 12, 2022 (Prospero registration number CRD42020194165). Hundred-twenty-six studies were included. In both the endemic and the epidemic setting, a median number of two out of seven predefined components of OI were identified. In the endemic setting, the most frequent component of OI was screening of the environment (28 studies, 62.2%). In the epidemic setting, screening of the environment (72 studies, 88.9%), and screening of patients during hospitalization (30 studies, 37%) were most frequently performed. Only 19 out of 126 studies (15.1%) reported screening of contact patients, and 37 studies reported screening of healthcare workers (HCW, 29.4%). Conclusion Due to probable underreporting of OI in the literature, the available evidence for the usefulness of the individual components of OI is scarce. This could lead to inhomogeneous performance of OI after detection of CRPA in the healthcare setting, and with this, potential under- or overscreening. While we could show evidence for the usefulness for environmental screening in order to identify the mode of transmission, evidence for HCW screening is scarce and might not lead to the identification of modes of transmission. Further studies are needed to better understand CI in different settings and, finally, develop guidance on when and how to best perform OI.

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Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Outbreak investigations after identifying carbapenem-resistant Pseudomonas aeruginosa: a systematic review

Büchler

Shahab

Severin

et al. 2023

Antimicrob Resist Infect Control

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“…Multidrug-resistant organism (MDRO) screening or surveillance culture reports are seldom performed in regions with higher prevalence and reported to have lower sensitivity with limited sites of sampling [19]. Treatment or decolonization for MDR Gram-negative organisms based on surveillance sampling is disapproved by many organizations and is only implicated as an infection control measure [20,21].…”

Section: Risk Factors For Infectionmentioning

confidence: 99%

Treatment of Acinetobacter baumannii

R. Warrier,

Radha

2023

Acinetobacter Baumannii - The Rise of a Resistant Pathogen

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Acinetobacter baumannii is a Priority 1 pathogen under the WHO list for research and discovery of new antibiotics. The epidemiology of the pathogen suggests its relevance as an important “healthcare-associated” pathogen—with the most common clinical syndrome being ventilator-associated pneumonia. Rising rates of carbapenem resistance in this pathogen have necessitated re-purposing of old drugs, use of high-dose regimens, and newer antimicrobial options. Combination therapy for carbapenem-resistant isolates, especially in sicker patients, is now advocated. Here, we describe the traditional treatment options and selection of drugs in multidrug- resistant infections, along with a brief review of the evidence followed by emerging treatment options.

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“…These measures include active screening, contact precautions and antimicrobial stewardship. 4 As opposed to incidental detection of CPO by way of routine clinical sampling, surveillance in the form of active screening enables early detection of colonised patients, thereby preventing further spread. 5 We retrospectively interrogated our microbiology database to determine the number of patients who were found to have a positive CPO screen within the last 2 years in accordance with the guidelines from Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland and National Services Scotland.…”

Section: Introductionmentioning

confidence: 99%

Carriage of multidrug-resistant carbapenemase-producing gram-negative bacteria in patients admitted to NHS Greater Glasgow and Clyde hospitals: Implications for treatment

Espie,

Marek,

Farrugia

et al. 2023

Journal of the Royal College of Physicians of Edinburgh

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Background: Infections caused by gram-negative carbapenemase-producing organisms (CPO) have become a global phenomenon. Screening of patients for CPO that was carried out at 48-h intervals enables early detection of carriers for infection control purposes and planning therapy. Methods: We investigated the bacterial flora detected on screening, the enzymes that conferred resistance and the proportion of patients who developed bacteraemia with CPO and their therapy. Results: In all, 27 patients had a positive screen for CPO. A small but significant (7.5%) proportion of patients were not detected on initial screening. Escherichia coli and Klebsiella were predominant. New-Delhi metallo β-lactamase and oxacillin carbapenemases were the main enzymatic mechanisms of resistance. Four (14.8%) patients developed bacteraemia with CPO (30- and 90-day survival 100% and 75%, respectively). Discussion: A single negative screen does not rule out colonisation. A significant proportion of patients colonised with CPO develop bacteraemia. Vigilance is needed to prevent the nosocomial spread of CPO.

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Effects of screening strategies to detect carbapenem-resistant gram-negative bacteria: A systematic review

Cited by 10 publications

References 33 publications

Outbreak investigations after identifying carbapenem-resistant Pseudomonas aeruginosa: a systematic review

Outbreak investigations after identifying carbapenem-resistant Pseudomonas aeruginosa: a systematic review

Treatment of Acinetobacter baumannii

Carriage of multidrug-resistant carbapenemase-producing gram-negative bacteria in patients admitted to NHS Greater Glasgow and Clyde hospitals: Implications for treatment

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