Use of a cohorting-unit and systematic surveillance cultures to control aKlebsiella pneumoniaecarbapenemase (KPC)–producing Enterobacteriaceae outbreak

Abstract

Objective:Describe the epidemiological and molecular characteristics of an outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing organisms and the novel use of a cohorting unit for its control.Design:Observational study.Setting:A 566-room academic teaching facility in Milwaukee, Wisconsin.Patients:Solid-organ transplant recipients.Methods:Infection control bundles were used throughout the time of observation. All KPC cases were intermittently housed in a cohorting unit with dedicated nurses and nursing aids. The rooms used in the cohorting unit had anterooms where clean supplies and linens were placed. Spread of KPC-producing organisms was determined using rectal surveillance cultures on admission and weekly thereafter among all consecutive patients admitted to the involved units. KPC-positive strains underwent pulsed-field gel electrophoresis and whole-genome sequencing.Results:A total of 8 KPC cases (5 identified by surveillance) were identified from April 2016 to April 2017. After the index patient, 3 patients acquired KPC-producing organisms despite implementation of an infection control bundle. This prompted the use of a cohorting unit, which immediately halted transmission, and the single remaining KPC case was transferred out of the cohorting unit. However, additional KPC cases were identified within 2 months. Once the cohorting unit was reopened, no additional KPC cases occurred. The KPC-positive species identified during this outbreak included Klebsiella pneumoniae, Enterobacter cloacae complex, and Escherichia coli. blaKPC was identified on at least 2 plasmid backbones.Conclusions:A complex KPC outbreak involving both clonal and plasmid-mediated dissemination was controlled using weekly surveillances and a cohorting unit.

Early experience with COVID-19 patients in a private tertiary hospital in the Philippines: Implications on surge capacity, healthcare systems response, and clinical care

“… 26 However, isolation and cohorting are difficult to sustain because of higher cost and increased workload for the healthcare team. 27 , 28 In addition, adverse events such as increased patient anxiety, anger or feeling of isolation, increased falls, and less time spent with the healthcare team, have been reported 29 -- events that we also observed for some of our patients.…”

A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associatedC. difficileand multidrug-resistant organisms

“…3,6,10,23,25,27,[31][32][33][35][36][37][38][39][40][45][46][47]51,53,56,61,63,69,73,75,76,[78][79][80][81]86,[92][93][94][95][96][97][98] Most studies (65 of 87, 74.7%) were performed in the setting of an outbreak, 4,6,10,20,21,23,28,32,38,40,41,43,44,54,57,62,68,70,73,75-81, 83,86,89,93-95 and the rest were not. Most focused on specific pathogens, including MRSA (n = 22), 3,22,24,26,28,[32][33][34][37][38][39]...…”

“…Cohorting was performed in the setting of other infection control interventions, either maintained throughout the duration of the interventions (56 of 87, 64.4 %) or limited to certain phases (31 of 87, 35.6%). 3,5,8,19,20,26,28,31,32,[36][37][38][39]46,49,50,[53][54][55][56]63,64,67,69,70,77,78,85,87,89,93 In 55 of the 87 included studies (63%), cohorting was described as the physical separation of patients within a section of a unit. In 34 studies (39%), a dedicated area or ward was created for patients, 3,4,6,19,23,29,32,33,[35][36][37][38]41,[43][44][45]47,59,…”

“…6,10,20,21,24,26,30,32,35,37,38,40,41,43,44,51,54,62,65,70,77,[83][84][85]89,92,95 Potential adverse effects from cohorting were discussed in 12 studies. 8,19,25,28,33,34,44,59,61,78,86,89 These adverse effects included increased anxiety or feeling of isolation, 28,34 increased workload for the healthcare team, 61,78 higher cost, 19,33 disruption of patient care, 59,61 potentially less time spent with the healthcare team, 28 increase in other MDROs, 25 or no adverse effects. 8 In 1 study,…”

“…Carbapenem-resistant Enterobacteriaceae (CRE) and extendedspectrum β-lactamase (ESBL)-producing organisms Among the studies we evaluated, 22 investigated cohorting as part of an intervention to control drug-resistant Enterobacteriaceae, all in the setting of an outbreak. 9,10,27,31,36,46,49,51,52,58,59,[71][72][73]75,78,84,88,90,93,97,98 Most involved CRE, with the exception of 2 studies with ESBL-producing Klebsiella spp. 58,59 In both, rates of ESBL decreased; from 11.57 per 1,000 patient days to 0.08 per 1,000 patient days (RR, 0.11) in one study and from 8.6 per 1,000 patient days to 0 after intervention, in the other.…”