Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit

Szél, Borbála; Reiger, Zsolt; Urbán, Edit; Lázár, Andrea; Mader, Krisztina; Damjanova, Ivelina; Nagy, Kamilla; Tálosi, Gyula

doi:10.1007/s12519-016-0069-z

Cited by 11 publications

(25 citation statements)

References 29 publications

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“…Environmental contamination by ESBL-KP in NICU has been reported by Szél and colleagues, and has been associated to high prevalence of MDR-GNB carriage and infection. Successful elimination of ESBL-producing nosocomial bacteria was obtained thanks to the implementation of a multidisciplinary intervention based on reduction of invasive procedures, changes of the antibiotic policies, microbiological screening at short intervals, progressive feeding, safer bathing protocol, staff hand hygiene training and continuous monitoring of the number of newly infected and newly colonized patients (25). This interdisciplinary approach is aligned with ours for the most of the measures taken and our results are comparable.…”

Section: Discussionsupporting

confidence: 69%

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Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Saporito

Graziano²,

Mescolo³

et al. 2020

Preprint

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Background: Antimicrobial resistance in Neonatal Intensive Care Unit (NICU) patients is a threat, due to the large use of antimicrobial treatment and invasive devices in fragile babies.Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage is in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP) was observed in “Civico” hospital NICU. Aim: To estimate the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.Methods: Rectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). From November 2017 the following intervention measures were applied: a) two-months strengthening of sample collection; b) stakeholders’ meetings; c) improvement of prevention measures and antimicrobial policy. Prevalence of MDR-GNB carriage observed in the 12 months before and in the 24 months after intervention were compared by chi-square test. Risk factors for MDR-GNB carriage in a subgroup of patients were identified by a multivariate logistic regression model. Findings: During the strengthened microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), soother swabs (30.8%; 17.9%) and from a sub-intensive room surface. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. ESBL-KP was detected no more until June 2018. No MDR-GNB isolate was detected for three months. Prevalence of MDR-GNB and ESBL-KP carriage after intervention significantly decreased compared to the previous year (20.6% vs 62.2 %; p<0.001 and 11.1% vs 57.8%; p<0.001). Multivariate analysis of principal exposure variables showed that admission in post-intervention period significantly reduced the risk of MDR-GNB carriage (OR=0.15, p=0.01). Conclusions: MDR-GNB broadly circulate in NICU setting and can colonize different body sites and spread by various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of most dangerous ESBL-KP strains.

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Section: Discussionsupporting

confidence: 69%

“…But after few months, prevalence of MDR-GNB carriage raised again up to 70% in 2017 (Table 1). High prevalence of MDR-GNB carriage was reported from Ecuador (56%), Philippines (61%) and Hungary (> 50%) (25,26). Nevertheless, differences in local epidemiology, logistics and hospital organization must be considered.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Saporito

Graziano²,

Mescolo³

et al. 2020

Preprint

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“…Globally ESBL have been isolated and form a major contributor of antimicrobial resistance in Gram negative isolates 13 . Now a days ESBL producers are prime threat as nosocomial infections for hospitalized patients throughout around the globe 14 22 . Excessive and imprudent use of antibiotics, lack of the knowledge for the development of new formula drugs by the pharmaceutical industries contributes in the emergence of bacterial resistance 23 .…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Extended Spectrum Beta Lactamase Producing Gram Negative Rods

2019

J Liaquat Uni Med Health Sci

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OBJECTIVE: To estimate the distribution of ESBL producing capacity among different Gram negative isolates along with specimen and department wise prevalence in a tertiary care hospital. METHODOLGY: This cross-sectional study was conducted at the Microbiology section of Pathology Department, Allama Iqbal Medical College, Lahore, Pakistan, from August 2016 to January 2017. Total of 437 clinical samples were collected from different wards of Jinnah Hospital, Lahore. Sample was cultured on Blood agar, MacConkey's agar, chocolate agar, CLED agar. After the identification every Gram negative isolate was further processed for the antibiotic susceptibility testing following Modified Kirby Bauer disc diffusion method. ESBL detection was performed by the combination drugs disc method using ceftriaxone + clavulanic acid (30/10 µg) in case of Enterobacteriacae, ceftazidime + clavulanic acid (30/10µg) in case of Pseudomonas species. RESULTS: Among total 437 patients male and female were 61% and 39% respectively, overall 21.5% (94/437) were ESBl producers. Distribution of ESBL producers was as followed Acinetobacter spp 22.3% (31/139), Escherichia coli 37.5% (27/72), Klebsiella spp 31.9% (15/47), Pseudomonas aeruginosa 8.4% (13/154) and Proteus spp 32.0% (8/25). Department wise ESBL positivity was as followed Surgical units 25.6% (32/125) Medical unit 31.9% (30/94), Burn centre 10% (8/80), ICU 20% (8/40) Surgical Allied 11.7% (4/34), Medical Allied 6.2% (2/32), Neurology 36.3% (8/22), Gynaecology 28.5% (2/7) and Dermatology 33.3% (1/3). CONCLUSION: High percentage of ESBL positivity seen in Escherichia coli and Proteus spp, among departments neurology and medical unit is holding maximum positivity. High frequency of ESBL producing Gram negative isolates strongly recommend its detection and management accordingly. It can lead to treatment failures in Gram negative rods associated infections.

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“…16 studies (see Table 2) focussed on Clostridium difficile 112,113,122-127,114-121 and 18 studies (see Table 3) focussed on Klebsiella pneumoniae 128,129,[138][139][140][141][142][143][144][145][130][131][132][133][134][135][136][137] . The studies varied in their designs with majority being quasi-experiments (31 articles).…”

Section: Characteristics Of Selected Studiesmentioning

confidence: 99%

Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Okeah

Huws

Morrison

2020

Preprint

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Background: According to the European Center for Disease Prevention and Control (ECDC), the EU records an estimated 3.2 million healthcare associated infections (HAIs) and an associated 37,000 deaths annually. A significant proportion of the HAIs burden is attributable to multi-drug resistant pathogens. Infectious diseases remain top on the list of the leading causes of death globally with multi-drug resistant microorganisms (MDROs) playing a significant role. Aims: To assess the breadth of studies on antibiotics stewardship C. diff and Klebsiella pneumoniae in healthcare settings. To identify existing literature on the interventions for reducing healthcare associated C. diff and Klebsiella pneumoniae transmission. Methods: This scoping review was undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines. The specific databases searched included MEDLINE, PubMed, Web of Science Core Collection, and CINAHL. The process for screening articles and data extraction was undertaken in duplicate by two reviewers. A narrative synthesis of the results is provided. Results: The review included 34 studies (16 studies on Clostridium difficile and 18 articles focussed on Klebsiella pneumoniae). These interventions include Education, Surveillance/Screening, Consultations, Audits, Policies/Protocols, Environmental disinfection, Bundles, Isolation, and Notifications or alerts (ESCAPE-BIN). A study involving screening, alerts, staff education, and antimicrobial protocols recorded a 75% reduction in the use of targeted antimicrobials. The largest absolute reduction in antimicrobial use of 310 DDs/1000PDs was reported from an intervention that involved audits and feedback systems. The highest improvement (95%) in adherence was reported by an intervention involving the use of an infection prevention bundle and an environmental cleaning protocol. Conclusion: Antimicrobial resistance represents a global threat requiring urgent measures to protect lives. Reducing the burden of AMR entails a host of multi-level approaches aimed at curbing transmission of the resistant pathogens, and optimizing the use of antibiotics.

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Successful elimination of extended-spectrum beta-lactamase (ESBL)-producing nosocomial bacteria at a neonatal intensive care unit

Abstract: Colonizations and infections were rolled back successfully in a multi-step effort that required an interdisciplinary approach.

Cited by 11 publications

References 29 publications

Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

Epidemiology of Extended Spectrum Beta Lactamase Producing Gram Negative Rods

Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

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