Preemptive isolation and active surveillance in the prevention and control of nosocomial infection reduce the incidence of carbapenem-resistant Enterobacteriaceae

Chang

et al. 2021

JCM

Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan–Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05–41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73–26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29–12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.

Section: Discussionmentioning

confidence: 99%

Prolonged Carriage of Carbapenemase-Producing Enterobacteriaceae: Clinical Risk Factors and the Influence of Carbapenemase and Organism Types

Chang

et al. 2021

JCM

“…Hospitals attempt to prevent and control nosocomial infections by a range of methods, including engineering solutions, strict hand hygiene, and wearing face masks [5,[17][18][19]. Infection control is particularly important in intensive care units (ICUs), where the focus is on environmental and air cleanliness to prevent colonization turning to pathogenesis and to enhance pathogen clearance.…”

Section: Infectious Diseases That Cause Community Infections Can Alsomentioning

confidence: 99%

Study on the purification effect of a pediatric isolation bed on the air in general hospital wards

Liu¹,

Wang²,

Hao³

et al. 2019

Preprint

Background: Patients with acute infectious respiratory illness may emit bio-aerosols containing pathogens capable of infecting susceptible hosts, including other patients and healthcare workers.This study aimed to evaluate the purification effect of a pediatric isolation bed on aerosols and microorganisms in the air in experiment rooms and verify the purification efficiency in general wards.Methods: Experiments were carried out in two settings: one with isolation bed and the other with regular bed. Using a dust particle counter to discriminate particles sizes in the air and using Anderson's six levels to discriminate S. albicans, the purification rate in the two rooms was evaluated.The concentration of cigarette particles(size 0.3-0.5 μm,0.5-1.0μm ) and S. albicans in the air was significantly decreased in the experimental room, indicating that the air was purified. Then detection the aerosol in the room to vilidaty the purification rate.Finally detection of aerosol and sedimentation bacteria in the air of general wards.Results: Isolation beds in demonstration ward have a purifying effect on both aerosols and sedimentation bacteria.Conclusions:Isolation bed can therefore be used in hospitals to reduce the risk of nosocomial infection and protect the health of doctors, patients, and visiting relatives.

“…active surveillance combined with early or preemptive isolation could reduce the spread of carbapenemresistant enterobacteria (CRE), decreasing carriage rates from 9.8-7.6%, and infection rates from 5.2-2.8% (5). A meta-analysis of 10 observational studies demonstrated CRE-colonized patients had a 16.5% risk of infection.…”

mentioning

confidence: 99%

Active Surveillance of Carbapenem-resistant Gram-negative Bacteria to guide antibiotic therapy: a single-center prospective observational study

Liang

Chen

et al. 2021

Preprint

Self Cite

Background Carbapenem-resistant Gram-negative Bacteria (CRGNB) have become a public health concern worldwide. The risk factors associated with CRGNB infection after colonization are unknown, nor is the optimal timing of antibiotic treatment, warranting further investigation. Methods A 4-year single-center prospective observational study was conducted. CRGNB-colonized patients were incorporated on admission into our observation cohort for an active surveillance culture program, and analysis of risk factors associated with infections after CRGNB colonization was performed. We divided patients into empirical antibiotic therapy groups and standard antibiotic therapy groups according to whether antibiotics were used before or after cultures yielded a result to explore the relationship between the timing of antibiotics and clinical efficacy. Results 152 out of 451 CRGNB-colonized patients in the prospective observational cohort developed CRGNB infection. The risk factors associated with CRGNB infection after colonization included CRKP (P < 0.001, OR = 3.27) and CRPA (P < 0.001, OR = 2.97) colonization, history of carbapenems use (P < 0.001, OR = 5.48), and immunocompromise (P < 0.001, OR = 7.07). There were 88 infected patients in the empirical antibiotic therapy groups and 64 in standard antibiotic therapy groups. The mortality was lower in empirical therapy groups than standard therapy groups (17.0% vs. 37.5%, P = 0.004, OR = 0.32). Conclusions CRGNB colonization increased the risk of infection, and risk factors included CRKP and CRPA colonization, immunocompromise, and prior carbapenems use. Once infection occurs in CRGNB-colonized patients, susceptibility-guided antibiotic treatment can be given according to previous susceptibility results of colonized CRGNB, reducing mortality.