The Pros, Cons, and Unknowns of Search and Destroy for Carbapenem-Resistant Enterobacteriaceae

Moodley, Prashini; Whitelaw, Andrew

doi:10.1007/s11908-015-0483-8

Cited by 3 publications

(4 citation statements)

References 83 publications

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“…Despite the inclusion of IPC and antibiotic stewardship in the Saudi Arabian strategic plan to mitigate the antibiotic resistance challenge [ 8 ], there is little information on the implementation and outcome of IPC interventions to date, particularly in healthcare facilities where elevated resistance has become endemic [ 9 ]. Knowledge of the local epidemiology of antibiotic-resistant isolates in ICU-acquired MDR-GNB could inform IPC and/or antimicrobial stewardship programs to achieve better patient outcomes [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit

Althaqafi¹,

Yaseen²,

Farahat³

et al. 2023

Cureus

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Background Multidrug-resistant Gram-negative bacteria (MDR-GNB) present a significant and escalating hazard to healthcare globally. Context-specific interventions have been implemented for the prevention and control of MDR-GNB in several healthcare facilities. The objective of this study was to implement and evaluate the effectiveness of evidence-based interventions in the incidence and dissemination of MDR-GNB. Methods This was a pre-and post-intervention study conducted in three phases at King Abdulaziz Medical City Jeddah, Saudi Arabia. During Phase-1, the data on each of the four MDR-GNB ( Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli ) were collected prospectively. Genomic fingerprinting was performed on isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine clonality and establish a link between different strains within and between the hospital wards/units. In the second phase, targeted interventions were implemented in the adult intensive care unit (ICU) based on previously determined risk factors and included the education of healthcare workers on hand hygiene, disinfection of patients’ surrounding, daily chlorhexidine baths, and disinfection rooms on discharge with hydrogen peroxide fogging after MDR-GNB patients were discharged. An antibiotic restriction protocol was simultaneously implemented as part of the hospital antibiotic stewardship program. In the third phase, the effectiveness of the interventions was evaluated by comparing the incidence rate and clonality (using ERIC-PCR genetic fingerprints) of MDR-GNB before and after the intervention. Results A significant reduction of MDR-GNB was observed in Phase-2 and Phase-3 compared with Phase-1. The mean incidence rate of MDR-GNB per 1000 patient days in Phase-1 (pre-intervention) was 11.08/1000, followed by 6.07 and 3.54/1000 in Phase-2 and Phase-3, respectively. A statistically significant reduction was observed in the incidence rate of MDR-GNB in the adult ICU (P=0.007), whereas no statistically significant decrease (P=0.419) was observed in areas other than the adult ICU. Two A. baumannii strains appear to be circulating within the ICU environment with reduced frequency in Phase-2 and Phase-3 compared to Phase-1. Conclusion There was a significant reduction in the incidence of MDR-GNB in the adult ICU due to the successful implementation of both infection control and stewardship interventions, albeit challenging to ascertain the relative contribution of each.

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Section: Introductionmentioning

confidence: 99%

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit

Althaqafi¹,

Yaseen²,

Farahat³

et al. 2023

Cureus

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“…[8][9][10] However, more and more studies have shown that the drug resistance of AB has generally increased; the prevalence of CRAB has increased worldwide, and numerous hospital outbreaks in ICUs have been reported. [11][12][13][14] Some studies have even suggested enhanced stewardship programs are urgently needed and have been developed to avoid the spread and potential outbreaks by MDRAB, especially in high-resistance endemic settings. 15,16 Consequently, the relative efficacy of ICP and AMS is still inconclusive and controversial when it comes to controlling MDRAB and XDRAB.…”

Section: Introductionmentioning

confidence: 99%

“…15,16 Consequently, the relative efficacy of ICP and AMS is still inconclusive and controversial when it comes to controlling MDRAB and XDRAB. 11,12 Environmental cleaning (ENC) is an important component of a comprehensive strategy to control healthcareassociated infections, especially in wards such as the ICU, where patients are compromised. 17,18 One study showed that comprehensive measures with environmental cleaning in a NICU environment were effective and significantly reduced the incidence rate of methicillin-resistant Staphylococcus aureus.…”

Section: Introductionmentioning

confidence: 99%

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<p>Successful Incidences of Controlling Multidrug-Resistant, Extensively Drug-Resistant, and Nosocomial Infection <em>Acinetobacter baumannii</em> Using Antibiotic Stewardship, Infection Control Programs, and Environmental Cleaning at a Chinese University Hospital</p>

Liu¹,

Liu²,

Li³

2020

IDR

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Objective: We estimated the efficacy of antimicrobial stewardship (AMS), infection control programs (ICP), and environmental cleaning (ENC) for controlling the resistance of Acinetobacter baumannii (AB) and controlling the incidence of multidrug-resistant AB (MDRAB), extensively drug-resistant AB (XDRAB), and nosocomial infection AB in the ICU (NIAB-ICU) at a university hospital. Methods: The intervention included 4-year AMS+ICP and 3-year AMS+ICP+ENC between January 2012 and December 2019. Results: A total of 2636 AB isolates were collected totally, and 64.98% of AB isolates were MDR and 29.97% were XDR. Preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP measures ranged from 84.96% to 71.98%, 41.96% to 33.13%, and 45.6% to 38%, respectively. However, all of them were not statistically changed (P=0.085, 0.072, 0.061, separately). The preintervention and postintervention incidences of MDRAB, XDRAB, and NIAB-ICU by AMS+ICP+ENC measures ranged from 71.98% to 36.55%, 33.13% to 19.88%, and 38% to 22.5%, respectively. Statistically significant declines were observed (P=0.016, 0.041, 0.032, separately). The defined daily doses (DDD) per 1000 patient-days (PD) decreased from 45±3.3 to 30.81±1.5 per 1000 PD across from 2012 to 2019, and a statistical decline was seen (P=0.01). Concurrently, the alcohol-based hand gel (ABHG) consumption per 1000 PD increased from 0.6±0.05 L to 12.5±2.3 L per 1000 PD, and a statistical increase was observed (P=0.0001). A statistically positive correlation was revealed between the DDD and incidence of MDRAB, XDRAB, and NIAB-ICU (r=0.905 and p=0.002; r=0.939 and p=0.001; r=0.956 and p=0.0002; respectively). Simultaneously, a statistically negative correlation was showed between the ABHG and incidence of MDRAB, XDRAB, and NIAB-ICU (r= −0.858 and p=0.006; r=−0.888 and p=0.003; r=−0.882 and p=0.004, separately). Conclusion: The AMS, ICP, and ENC may be one of the most effective and best measures to address the increasing incidence of MDRAB, XDRAB, and NIAB-ICU currently.

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Cross Sectional Study on a Spectrum of Bacterial Pathogens under Actions of Infection Control in Different Clinical Specimens of ICU Patients of Sajer General Hospital in Saudi Arabia, and Their Antibiotic Sensitivity Pattern

Alenezi¹,

El-Tahtawi²,

Makhlouf³

2021

jemds

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BACKGROUND The intensive care unit (ICU) is a special department of the hospital and health care setting that provides intensive nursing care and care to patients with the most severe and life-threatening illnesses and injuries that require accurate, continuous monitoring and support from specialist, medication, and equipment in order to maintain normal bodily functions. Nosocomial infections are one of the leading causes of mortality in hospitalised patients especially the critically ill patients in the intensive care unit. The purpose of the present study was isolation, identification, and detection of the antibiotic sensitivity pattern of pathogenic bacteria isolated from different clinical specimens of ICU patients under the effect of infection control in Sajer General Hospital in Saudi Arabia. METHODS In this cross-sectional study conducted from January 2020 to April 2020, 200 clinical samples, 40 blood, 45 urine, 50 tracheal aspirate, 30 post-surgical Caesarean section wound swabs, 20 central venous catheters and 15 pus swabs were collected from patients hospitalised in ICUs of Sajer General Hospital. Antibiotic sensitivity testing was performed with the diffusion-disk method for several antibiotics. RESULTS The rate of nosocomial infection among ICU patients due to Gram-negative bacteria is significantly higher than that recorded by Gram-positive bacteria (78.75 %, 21.25 %, respectively). The majority of frequent bacteria isolated from all clinical specimens were Klebsielleae pneumoniae 20 (25 %) followed by Pseudomonas aeruginosa 18 (22.5 %), Acinetobacter baumannii 15 (18.75 %), Escherichia coli 10 (12.50 %), Staphylococcus aureus 9 (11.25 %), Streptococcus pyogenes 6 (7.50 %) and enterococcus spp. 2 (2.50 %). K. pneumoniae, P. aeruginosa and E. coli achieved high sensitivity to imipenem and meropenem (100 %). A. baumannii showed high sensitivity to meropenem (100 %) and imipenem (93.33 %). Staph. aureus, Streptococcus pyogenes and enterococcus species showed high sensitivity to vancomycin (100 %). CONCLUSIONS The nosocomial infection is a major cause of mortality and morbidity in hospitals. The role of nursing care in the prevention of nosocomial infection has proven vital due to the emergence and spreading of different pathogenic bacteria. Close interactions between health care providers can save many more lives. KEY WORDS Intensive Care Units, Antibiotics Sensitivity Pattern, Nursing Infection Control

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The Pros, Cons, and Unknowns of Search and Destroy for Carbapenem-Resistant Enterobacteriaceae

Cited by 3 publications

References 83 publications

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit

<p>Successful Incidences of Controlling Multidrug-Resistant, Extensively Drug-Resistant, and Nosocomial Infection <em>Acinetobacter baumannii</em> Using Antibiotic Stewardship, Infection Control Programs, and Environmental Cleaning at a Chinese University Hospital</p>

Cross Sectional Study on a Spectrum of Bacterial Pathogens under Actions of Infection Control in Different Clinical Specimens of ICU Patients of Sajer General Hospital in Saudi Arabia, and Their Antibiotic Sensitivity Pattern

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