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Calbo E, Gisbert L, López-Sánchez M. Investigating outbreaks in neonatal intensive care units: A crucial battle in the cradle of care. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024; 42:283-285. [PMID: 38839161 DOI: 10.1016/j.eimce.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Esther Calbo
- Servicio de Enfermedades Infecciosas Hospital Universitario Mútua de Terrassa, Spain; Equipo Control de Infección, Spain; Universitat Internacional de Catalunya, Spain.
| | - Laura Gisbert
- Servicio de Enfermedades Infecciosas Hospital Universitario Mútua de Terrassa, Spain
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Catton T, Umpleby H, Dushianthan A, Saeed K. Provision of Microbiology, Infection Services and Antimicrobial Stewardship in Intensive Care: A Survey across the Critical Care Networks in England and Wales. Antibiotics (Basel) 2023; 12:antibiotics12040768. [PMID: 37107130 PMCID: PMC10135214 DOI: 10.3390/antibiotics12040768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads for ICUs in each region listed in the Critical Care Network for the UK. Out of 217 ICUs, 87 deduplicated responses from England and Wales were analyzed. Three-quarters of those who responded had a dedicated microbiologist, and 50% had a dedicated infection control prevention nurse. Infection rounds varied in their frequency, with 10% providing phone advice only. Antibiotic guidance was available in 99% of the units; only 8% of those were ICU-specific. There were variations in the availability of biomarkers & the duration of antibiotics prescribed for pneumonia (community, hospital, or ventilator), urinary, intra-abdominal, and line infections/sepsis. Antibiotic consumption data were not routinely discussed in a multi-disciplinary meeting. The electronic prescription was available in ~60% and local antibiotic surveillance data in only 47% of ICUs. The survey highlights variations in practice and AMS services and may offer the opportunity to further collaborations and share learnings to support the safe use of antimicrobials in the ICU.
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Affiliation(s)
- Tim Catton
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
| | - Helen Umpleby
- Department of Infection, Hampshire Hospitals NHS Foundation Trust, Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK
| | - Ahilanandan Dushianthan
- General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, and the University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
| | - Kordo Saeed
- Faculty of Medicine, University of Southampton, Tremona Road, Southampton SO16 6YD, UK
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK
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AbiGhosn J, AlAsmar M, Abboud E, Bailey BA, Haddad N. The Effect of Infection Precautions on Extended-Spectrum Beta-Lactamase Enterobacteriaceae Colonization Among Nurses in Three Beirut Hospitals. Cureus 2022; 14:e23849. [PMID: 35530839 PMCID: PMC9071177 DOI: 10.7759/cureus.23849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objective Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) are rapidly emerging worldwide. This study aimed to assess the effect of contact precaution (CP) on ESBL-PE-colonization rates among nurses in three hospitals in Beirut, Lebanon, where ESBL is endemic, in order to define the risk factors for colonization. Accordingly, the ongoing use of CP to prevent ESBL-PE transmission to healthy nurses was evaluated. Methods This cross-sectional study was conducted in three hospitals. Hospital 1 required CP, Hospital 2 had recently stopped CP, and Hospital 3 had stopped it three years previously. Questionnaires and stool-collection containers were distributed to all patient care nurses in those three hospitals. The Returned samples were tested using the agar dilution technique. Results A total of 269 out of 733 nurses volunteered to participate; 140 met the inclusion criteria (no recent hospitalization, antibiotic use, or known ESBL-PE colonization) and provided samples. Among them, 15% were ESBL-positive. Compared to nurses from Hospital 3, nurses from Hospital 1 were 59% less likely to be colonized, while nurses from Hospital 2 were 62% more likely to be colonized. Conclusion In hospitals where CP is in place for ESBL-positive patients, ESBL-PE prevalence in nursing staff was significantly lower. Additionally, a work experience of two to four years increased the odds of ESBL-PE colonization in comparison with longer nursing experience. CP may be a justifiable means of protection against ESBL-PE transmission to healthy nurses. The risk factors for colonization were discontinuation of CP and a shorter clinical work experience.
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Vuichard-Gysin D, Nueesch R, Fuerer RL, Dangel M, Widmer A. Measuring perception of mental well-being in patients under isolation precautions: a prospective comparative study. BMJ Open 2022; 12:e044639. [PMID: 35314467 PMCID: PMC8938694 DOI: 10.1136/bmjopen-2020-044639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Isolation precautions (IP) are applied to prevent transmission of pathogens in healthcare settings. Potential negative health outcomes experienced by patients have been previously described but results remain conflicting. We aimed at evaluating the psychological impact of IP in adult patients in isolation using a novel psychological assessment tool. STUDY DESIGN Prospective matched cohort study. SETTING Tertiary care centre in Switzerland. PARTICIPANTS Hospitalised patients under IP and non-isolated patients were matched by ward, age and illness severity. OUTCOME MEASURES We measured surrogates of mental and social well-being by using the Pictorial Representation of Illness and Self Measure (PRISM) instrument once during hospitalisation. PRISM is a visual psychometric instrument that has been validated as a quantitative measure of suffering. Smaller distance in self-to-illness separation (SIS) signifies higher importance for a patient. RESULTS 156 patients agreed to participate of which 63 were under IP and 93 were matched controls. Median (IQR) duration of isolation was 5 days (2-10). The median SIS (IQR) for perceived inferior nurses' care was 22.8 (18.5-24.3) and 23.8 (23.3-25.5) for isolated and non-isolated patients, respectively (p<0.001). Similarly, median SIS (IQR) was significantly smaller in isolated than non-isolated patients for avoidance by visitors with 17.5 (7.7-22.0) and 22.2 (21.8-22.6), for loneliness with 7.5 (3.6-16.0) and 18 (10.2-21.6) and for feeling impure with 19 (17.0-21.5) and 21.5 (18.9-22.1), respectively (all p values<0.05). CONCLUSIONS IP to prevent transmission of pathogens may negatively impact mental and social well-being. Measures to alleviate adverse effects of IP should be taken routinely.
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Affiliation(s)
- Danielle Vuichard-Gysin
- Internal Medicine, Spital Thurgau AG, Muensterlingen, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Reto Nueesch
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
- Internal Medicine, Schwyz Hospital, Schwyz, Switzerland
| | | | - Marc Dangel
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Widmer
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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A systematic review of the effectiveness of cohorting to reduce transmission of healthcare-associated C. difficile and multidrug-resistant organisms. Infect Control Hosp Epidemiol 2021; 41:691-709. [PMID: 32216852 DOI: 10.1017/ice.2020.45] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking. METHODS We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals. RESULTS In total, 87 studies met inclusion criteria. Study types were quasi-experimental "before and after" (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistant Staphylococcus aureus (MRSA, n = 22), Clostridioides difficile infection (CDI, n = 6), vancomycin-resistant Enterococcus (VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22), A. baumannii (n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention. CONCLUSION Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO and C. difficile infections is difficult, particularly in endemic situations.
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Lynch JP, Clark NM, Zhanel GG. Escalating antimicrobial resistance among Enterobacteriaceae: focus on carbapenemases. Expert Opin Pharmacother 2021; 22:1455-1473. [PMID: 33823714 DOI: 10.1080/14656566.2021.1904891] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Over the past few decades, antimicrobial resistance (AMR) has skyrocketed globally among bacteria within the Family Enterobacteriaceae (i.e. Enterobacter spp, Klebsiella spp, Escherichia coli, Proteus spp, Serratia marcescens, Citrobacter spp, and others). Enterobacteriaceae are intestinal flora and are important pathogens in nosocomial and community settings. Enterobacteriaceae spread easily between humans and may acquire AMR via plasmids or other mobile resistance elements. The emergence and spread of multidrug resistant (MDR) clones have greatly limited therapeutic options. Some infections are untreatable with existing antimicrobials.Areas covered: The authors discuss the escalation of CRE globally, the epidemiology and outcomes of CRE infections, the optimal therapy, and the potential role of several new antimicrobials to combat MDR organisms. An exhaustive search for literature related to Enterobacteriaceae was performed using PubMed, using the following key words: antimicrobial resistance; carbapenemases; Enterobacterales; Enterobacteriaceae; Klebsiella pneumoniae; Escherichia coli; global epidemiology; metallo-β-lactamases; multidrug resistance; New Delhi Metalloproteinase-1 (NDM-1); plasmidsExpert opinion: Innovation and development of new classes of antibacterial agents are critical to expand effective therapeutic options. The authors encourage the judicious use of antibiotics and aggressive infection-control measures are essential to minimize the spread of AMR.
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Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology;The David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Nina M Clark
- The Division of Infectious Diseases, Department of Medicine, Stritch School of Medicine, Loyola University Chicago, Maywood, IL
| | - George G Zhanel
- Department of Medical Microbiology/Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp)-positive patients: A genomic exposé of cross-colonization hazards in a long-term acute-care hospital (LTACH). Infect Control Hosp Epidemiol 2020; 41:1162-1168. [PMID: 32624030 DOI: 10.1017/ice.2020.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits is often neglected. We searched for evidence of cross transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute-care hospital (LTACH), and we evaluated the impact of secondary acquisitions on resistance potential. DESIGN Genomic epidemiological investigation. SETTING A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp-positive patients. METHODS Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross transmission between cohorted patients. RESULTS Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient's isolate than to their own admission isolate. Of these 19 cases, 14 showed strong genomic evidence for cross transmission (<10 single nucleotide variants or SNVs), and most of these patients occupied shared cohort floors (12 patients) or rooms (4 patients) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates. CONCLUSIONS Acquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and they indicate the need for future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes.
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Rossi TM, Moore A, O'Sullivan TL, Greer AL. Risk factors for duration of equine rhinitis A virus respiratory disease. Equine Vet J 2019; 52:369-373. [PMID: 31710114 DOI: 10.1111/evj.13204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 10/31/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Infectious respiratory disease is common in young horses and can impact athletic performance and long-term health. Significant variation in the duration of clinical disease has been observed, even in the absence of secondary complications. The determination of factors associated with disease chronicity may facilitate clinical decision-making and the development of improved biosecurity protocols. OBJECTIVE To investigate contact network characteristics, and demographic variables associated with time to clinical recovery from Equine Rhinitis A virus respiratory disease. STUDY DESIGN Prospective cohort study. METHODS Yearling Standardbred racehorses (n = 58) housed in a multi-barn training facility in Southern Ontario were included. Horses were monitored daily for clinical signs of acute respiratory disease over a 41-day period in Autumn 2017. Contact patterns between horses, including older racehorses, were determined through use of proximity loggers attached to halters during the initial 7-day of the study. Associations between duration of disease, demographic factors (birth month, gait, sex and yearling sale), serologic titres and network metrics (degree, betweenness and Eigenvector centrality) were investigated using a Cox proportional hazard model. RESULTS Yearling attack rate for infectious respiratory disease was 87.9% (n = 51). Median time to recovery was 6 days (IQR = 1-32) and 17 horses were censored due to early withdrawal or failure to recover during the study period. In those yearlings born February-May, birth month was significant in the Cox proportional hazard model (Hazard Ratio 0.7, 95% CI 0.49-1, P = 0.05). MAIN LIMITATION Probability of censoring was not independent of outcome which necessitated use of sensitivity analysis. CONCLUSIONS These findings suggest late born foals are less likely to recover quickly from infectious respiratory disease.
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Affiliation(s)
- T M Rossi
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - A Moore
- Ontario Ministry of Agriculture, Food, and Rural Affairs, Guelph, Ontario, Canada
| | - T L O'Sullivan
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - A L Greer
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
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Mechergui A, Achour W, Mathlouthi S, Hassen AB. Prevalence of infectious multi-drug resistant bacteria isolated from immunocompromised patients in Tunisia. Afr Health Sci 2019; 19:2021-2025. [PMID: 31656485 PMCID: PMC6794499 DOI: 10.4314/ahs.v19i2.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Objectives A retrospective study was conducted in the Bone Marrow Transplant Center of Tunisia during a period of 10 years (from 2002 to 2011) in order to report the prevalence of infectious multi-drug resistant bacteria. Methods Bacterial identification was carried on the basis of biochemical characteristics and API identification systems. Antibiotic susceptibility was tested by disc diffusion method on Muller-Hinton agar. Results During the study period, 34.5% of 142 Klebsiella pneumoniae strains and 11.46% of 218 Escherichia coli strains were extended-spectrum beta-lactamase (ESBL) producers. Also, 32.8% of 210 strains of Pseudomonas aeruginosa were imipenem and/or ceftazidime resistant and 20.75% of 106 strains of Staphylococcus aureus were methicillin resistant. A rising trend was observed for the prevalence of the selected multidrug resistant bacteria. Conclusion These findings may have important clinical implications in prophylaxis and selection of antibiotic treatment. Continuous surveillance is needed, especially for onco-hematological patients.
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Affiliation(s)
- Arij Mechergui
- The National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- Faculty of Medicine of Tunis, UR12ES02, 1007, Tunis, Tunisia
| | - Wafa Achour
- The National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- Faculty of Medicine of Tunis, UR12ES02, 1007, Tunis, Tunisia
| | - Sondos Mathlouthi
- The National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- Faculty of Medicine of Tunis, UR12ES02, 1007, Tunis, Tunisia
| | - Assia Ben Hassen
- The National Bone Marrow Transplant Center, 1006, Tunis, Tunisia
- Faculty of Medicine of Tunis, UR12ES02, 1007, Tunis, Tunisia
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Blake DP. Key Ways to Prevent Infection When There Is No "Building": Aspects for the Field. Surg Infect (Larchmt) 2019; 20:115-118. [PMID: 30676276 DOI: 10.1089/sur.2018.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infection control is a critical aspect in the continuum of surgical care. Much of what is outlined in the literature pertains to hospital-based practice, with only recent attention paid to the more austere environments, particularly those faced during humanitarian or combat operations. OBJECTIVE This manuscript provides a brief historical review of the development of infection control practices and further identifies and outlines several aspects necessary to successful program applications in austere environments. RESULTS Hand hygiene remains the simplest form of infection control. Use of alcohol-based hand sanitizer is a logistically reasonable option for most circumstances, mitigating the requirement for clean running water to facilitate more traditional "soap and water" methods of hand disinfection. Environmental decontamination, patient cohorting, and patient isolation based on existing colonization/infection also has demonstrated efficacy in controlling cross-contamination and is feasible in most austere environments. Finally, senior leadership engagement with deliberate planning, antimicrobial stewardship, and vigorous quality and process improvement algorithms have resulted in reduced rates of critical infections in these settings. CONCLUSIONS Basic tenets of infection control can be achieved even in resource-poor environments. Meticulous attention to adhering to these principles, with support from senior medical and operational leadership, facilitates improvements in infection control outcomes. There remains, however, a need for additional robust outcomes data regarding best practices in these environments.
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Affiliation(s)
- David P Blake
- Division of Acute Care Surgery, Department of Surgery, Hartford Hospital, Hartford, Connecticut and Department of Surgery, Uniformed Services University of the Health Sciences F. Edward Hébert School of Medicine, Bethesda, Maryland
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Li M, Wang X, Wang J, Tan R, Sun J, Li L, Huang J, Wu J, Gu Q, Zhao Y, Liu J, Qu H. Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study. Antimicrob Resist Infect Control 2019; 8:8. [PMID: 30651974 PMCID: PMC6329090 DOI: 10.1186/s13756-018-0453-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 12/12/2018] [Indexed: 12/20/2022] Open
Abstract
Objective To determine whether infection-prevention and control (IPC) interventions can reduce the colonisation and infection of intensive care unit (ICU)-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) in a general ICU ward in China. Methods We used a quasi-experimental before-and-after study design. The study was conducted in 4 stages: baseline period, January 2013-June 2013; IPC interventions period including de-escalation and targeted bundle interventions, July 2013-June 2014; modified IPC interventions period, July 2014-June 2015; and follow-up period, July 2015-June 2016. We used modified de-escalation interventions according to patient-risk assessments to prevent the transmission of CRKP. Results A total of 629 patients were enrolled in study. The incidence of ICU-acquired CRKP colonisation/infection was 10.08 (4.43-16.43) per 1000 ICU patient-days during the baseline period, and significantly decreased early during the IPC interventions, but the colonisation/infections reappeared in April 2014. During the modified IPC intervention and follow-up periods, the incidence of ICU-acquired CRKP colonisations/infections reduced to 5.62 (0.69-6.34) and 2.84 (2.80-2.89), respectively, with ongoing admission of cases with previously acquired CRKP. The incidence of ICU-acquired CRKP catheter-related bloodstream infections decreased from 2.54 during the baseline period to 0.41 during the follow-up period. The incidence of ventilator-associated pneumonia and skin and soft tissue infections showed a downward trend from 2.84 to 0.41 and from 3.4 to 0.47, respectively, with slight fluctuations. Conclusions Comprehensive IPC interventions including de-escalation and targeted bundle interventions showed a significant reduction in ICU-acquired CRKP colonisations/infections, despite ongoing admission of patients colonised/infected with CRKP.
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Affiliation(s)
- Meiling Li
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Xiaoli Wang
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Jiahui Wang
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Ruoming Tan
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Jingyong Sun
- 2Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Lei Li
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Jie Huang
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Jun Wu
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Qiuying Gu
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Yujin Zhao
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Jialin Liu
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
| | - Hongping Qu
- 1Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin ER Road, Shanghai, 200025 China
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Heinrichs A, Argudín MA, De Mendonça R, Deplano A, Roisin S, Dodémont M, Coussement J, Filippin L, Dombrecht J, De Bruyne K, Huang TD, Supply P, Byl B, Glupczynski Y, Denis O. An Outpatient Clinic as a Potential Site of Transmission for an Outbreak of New Delhi Metallo-β-Lactamase–producing Klebsiella pneumoniae Sequence Type 716: A Study Using Whole-genome Sequencing. Clin Infect Dis 2018; 68:993-1000. [DOI: 10.1093/cid/ciy581] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/11/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Amélie Heinrichs
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - Maria Angeles Argudín
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - Ricardo De Mendonça
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - Ariane Deplano
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - Sandrine Roisin
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - Magali Dodémont
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | - Julien Coussement
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
| | | | | | | | - Te-Din Huang
- Laboratory of Clinical Microbiology, Belgian National Reference Center for Monitoring Antimicrobial Resistance in Gram-negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - Philip Supply
- INSERM U1019, CNRS-UMR 8204, Center for Infection and Immunity of Lille, Institut Pasteur de Lille, Université de Lille, Lille, France
| | - Baudouin Byl
- Ecole de Santé Publique, Université Libre de Bruxelles
- Clinique d’Epidémiologie et d’Hygiène Hospitalière, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Youri Glupczynski
- Laboratory of Clinical Microbiology, Belgian National Reference Center for Monitoring Antimicrobial Resistance in Gram-negative Bacteria, CHU UCL Namur, Yvoir, Belgium
| | - Olivier Denis
- Laboratoire de Microbiologie, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels
- Ecole de Santé Publique, Université Libre de Bruxelles
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Ikeda Y, Shigemura K, Nomi M, Tabata C, Kitagawa K, Arakawa S, Fujisawa M. Infection Control Following an Outbreak of Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Isolated from Catheter-Associated Urinary Tract Infection. Jpn J Infect Dis 2018; 71:158-161. [PMID: 29491235 DOI: 10.7883/yoken.jjid.2017.330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present our experience with controlling an outbreak of extended-spectrum beta-lactamase (ESBL)-producing bacteria in catheter-associated urinary tract infection and the measures taken to prevent future outbreaks. In June 2015, 9 out of 44 hospitalized patients in the same ward tested positive for antibiotic-resistant bacteria in urine cultures, including ESBL-producing Klebsiella pneumoniae. Since these bacteria belonged to the same cluster, we concluded this was a localized outbreak. Seven out of 10 environmental tests detected resistant strains at 1,000 colony forming units/cm2 or more. After an outbreak, we undertook periodic monitoring by active surveillance culture (ASC) every 2 months, along with environmental wipe testing. Cleaning regimen was performed through alcohol disinfection 5 or 7 times a day, then changed to complex-type chlorine-based disinfectant cleaner once a day that includes potassium peroxymonosulfate. ASC revealed only one positive case of antibiotic-resistant strain after incorporating new infection controls. Only a few environmental tests were positive for the bacteria after the new cleaning regimen, suggesting this cleaner might be effective for inhibiting outbreaks. Our control measures successfully prevented further outbreak and inhibited the recurrence.
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Affiliation(s)
- Yasuhiro Ikeda
- Infection Control Team, Hyogo Prefectural Central Rehabilitation Hospital
| | - Katsumi Shigemura
- Department of Urology, Kobe University Graduate School of Medicine.,Division of Infectious Diseases, Department of International Health, Kobe University Graduate School of Health Sciences.,Infection Control Team, Kobe University Hospital
| | - Masashi Nomi
- Infection Control Team, Hyogo Prefectural Central Rehabilitation Hospital
| | - Chie Tabata
- Infection Control Team, Hyogo Prefectural Central Rehabilitation Hospital
| | - Koichi Kitagawa
- Division of Translational Research for Biologics, Department of Internal Related Medicine, Kobe University Graduate School of Medicine
| | | | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine
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14
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Teerawattanapong N, Kengkla K, Dilokthornsakul P, Saokaew S, Apisarnthanarak A, Chaiyakunapruk N. Prevention and Control of Multidrug-Resistant Gram-Negative Bacteria in Adult Intensive Care Units: A Systematic Review and Network Meta-analysis. Clin Infect Dis 2018; 64:S51-S60. [PMID: 28475791 DOI: 10.1093/cid/cix112] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background This study evaluated the relative efficacy of strategies for the prevention of multidrug-resistant gram-negative bacteria (MDR-GNB) in adult intensive care units (ICUs). Methods A systematic review and network meta-analysis was performed; searches of the Cochrane Library, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) included all randomized controlled trials and observational studies conducted in adult patients hospitalized in ICUs and evaluating standard care (STD), antimicrobial stewardship program (ASP), environmental cleaning (ENV), decolonization methods (DCL), or source control (SCT), simultaneously. The primary outcomes were MDR-GNB acquisition, colonization, and infection; secondary outcome was ICU mortality. Results Of 3805 publications retrieved, 42 met inclusion criteria (5 randomized controlled trials and 37 observational studies), involving 62068 patients (median age, 58.8 years; median APACHE [Acute Physiology and Chronic Health Evaluation] II score, 18.9). The majority of studies reported extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and MDR Acinetobacter baumannii. Compared with STD, a 4-component strategy composed of STD, ASP, ENV, and SCT was the most effective intervention (rate ratio [RR], 0.05 [95% confidence interval {CI}, .01-.38]). When ENV was added to STD+ASP or SCT was added to STD+ENV, there was a significant reduction in the acquisition of MDR A. baumannii (RR, 0.28 [95% CI, .18-.43] and 0.48 [95% CI, .35-.66], respectively). Strategies with ASP as a core component showed a statistically significant reduction the acquisition of ESBL-producing Enterobacteriaceae (RR, 0.28 [95% CI, .11-.69] for STD+ASP+ENV and 0.23 [95% CI, .07-.80] for STD+ASP+DCL). Conclusions A 4-component strategy was the most effective intervention to prevent MDR-GNB acquisition. As some strategies were differential for certain bacteria, our study highlighted the need for further evaluation of the most effective prevention strategies.
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Affiliation(s)
| | - Kirati Kengkla
- Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, and
| | - Piyameth Dilokthornsakul
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand
| | - Surasak Saokaew
- Center of Health Outcomes Research and Therapeutic Safety, School of Pharmaceutical Sciences, University of Phayao, and.,Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Selangor
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathumthani, Thailand
| | - Nathorn Chaiyakunapruk
- Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand.,School of Pharmacy, Monash University Malaysia, Selangor.,School of Pharmacy, University of Wisconsin- Madison ; and.,School of Population Health, University of Queensland, Brisbane, Australia
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15
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Chew KL, Lin RTP, Teo JWP. Klebsiella pneumoniae in Singapore: Hypervirulent Infections and the Carbapenemase Threat. Front Cell Infect Microbiol 2017; 7:515. [PMID: 29312894 PMCID: PMC5732907 DOI: 10.3389/fcimb.2017.00515] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 11/29/2017] [Indexed: 11/22/2022] Open
Abstract
Klebsiella pneumoniae remains a major pathogen responsible for localized infections such as cystitis and pneumonia, and disseminated infections that may result in severe sepsis and death. Invasive disease such as liver abscesses and endogenous endophthalmitis are associated with capsular serotypes K1 and K2. These infections require a prolonged course of antimicrobial treatment which has evolved over the years from inpatient treatment to outpatient parenteral antibiotic therapy. The emergence of plasmid-mediated resistance began with extended-spectrum β-lactamases (ESBLs) and AmpC β-lactamases. This was followed by carbapenemase genes and now plasmid transmissible colistin resistance (mcr), thus limiting viable treatment options. Plasmid-mediated carbapenemase production in Singapore was first reported in 1996. Carbapenemase production has since become the predominant mechanism of carbapenem resistance and incidence rates continue to increase over time. Although carbapenemases can occur in all Enterobacteriaceae, K. pneumoniae are the most common carrier of carbapenemase genes. Alternative treatment options are urgently required before the simplest infections, let alone invasive infections are left potentially untreatable. Clinical management requires guidance from robust laboratory testing methods to optimize patient outcomes. We explore past and present trends in treatment of K. pneumoniae infections, and discuss future treatment options and gaps in knowledge for further study.
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Affiliation(s)
- Ka Lip Chew
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
| | - Raymond T P Lin
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore.,National Public Health Laboratory, Ministry of Health of Singapore, Singapore, Singapore
| | - Jeanette W P Teo
- Department of Laboratory Medicine, National University Hospital, Singapore, Singapore
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16
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Gorrie CL, Mirceta M, Wick RR, Edwards DJ, Thomson NR, Strugnell RA, Pratt NF, Garlick JS, Watson KM, Pilcher DV, McGloughlin SA, Spelman DW, Jenney AWJ, Holt KE. Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients. Clin Infect Dis 2017; 65:208-215. [PMID: 28369261 PMCID: PMC5850561 DOI: 10.1093/cid/cix270] [Citation(s) in RCA: 292] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/21/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Klebsiella pneumoniae is an opportunistic pathogen and leading cause of hospital-associated infections. Intensive care unit (ICU) patients are particularly at risk. Klebsiella pneumoniae is part of the healthy human microbiome, providing a potential reservoir for infection. However, the frequency of gut colonization and its contribution to infections are not well characterized. METHODS We conducted a 1-year prospective cohort study in which 498 ICU patients were screened for rectal and throat carriage of K. pneumoniae shortly after admission. Klebsiella pneumoniae isolated from screening swabs and clinical diagnostic samples were characterized using whole genome sequencing and combined with epidemiological data to identify likely transmission events. RESULTS Klebsiella pneumoniae carriage frequencies were estimated at 6% (95% confidence interval [CI], 3%-8%) among ICU patients admitted direct from the community, and 19% (95% CI, 14%-51%) among those with recent healthcare contact. Gut colonization on admission was significantly associated with subsequent infection (infection risk 16% vs 3%, odds ratio [OR] = 6.9, P < .001), and genome data indicated matching carriage and infection isolates in 80% of isolate pairs. Five likely transmission chains were identified, responsible for 12% of K. pneumoniae infections in ICU. In sum, 49% of K. pneumoniae infections were caused by the patients' own unique strain, and 48% of screened patients with infections were positive for prior colonization. CONCLUSIONS These data confirm K. pneumoniae colonization is a significant risk factor for infection in ICU, and indicate ~50% of K. pneumoniae infections result from patients' own microbiota. Screening for colonization on admission could limit risk of infection in the colonized patient and others.
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Affiliation(s)
- Claire L Gorrie
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne
| | - Mirjana Mirceta
- Microbiology Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Ryan R Wick
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute
| | - David J Edwards
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute
| | - Nicholas R Thomson
- Wellcome Trust Sanger Institute, Hinxton, Cambridgeshire, United Kingdom
| | - Richard A Strugnell
- Department of Microbiology and Immunology at the Peter Doherty Institute for Infection and Immunity, The University of Melbourne
| | | | | | | | - David V Pilcher
- Intensive Care Unit, The Alfred Hospital
- Australian and New Zealand Intensive Care - Research Centre, School of Public Health and Preventive Medicine, Monash University
| | - Steve A McGloughlin
- Intensive Care Unit, The Alfred Hospital
- Australian and New Zealand Intensive Care - Research Centre, School of Public Health and Preventive Medicine, Monash University
| | - Denis W Spelman
- Microbiology Unit & Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Adam W J Jenney
- Microbiology Unit & Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Kathryn E Holt
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute
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17
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Alves M, Lemire A, Decré D, Margetis D, Bigé N, Pichereau C, Ait-Oufella H, Baudel JL, Offenstadt G, Guidet B, Barbut F, Maury E. Extended-spectrum beta-lactamase--producing enterobacteriaceae in the intensive care unit: acquisition does not mean cross-transmission. BMC Infect Dis 2016; 16:147. [PMID: 27075040 PMCID: PMC4831109 DOI: 10.1186/s12879-016-1489-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022] Open
Abstract
Background In intensive care unit (ICU), infection and colonization by resistant Gram-negative bacteria increase costs, length of stay and mortality. Extended-spectrum beta-lactamase − producing Enterobacteriaceae (ESBL-E) is a group of pathogens increasingly encountered in ICU setting. Conditions that promote ESBL-E acquisition are not completely understood. The increasing incidence of infections related to ESBL-E and the unsolved issues related to ESBL-E cross-transmission, prompted us to assess the rates of referred and acquired cases of ESBL-E in ICU and to assess patient-to-patient cross-transmission of ESBL-E using a multimodal microbiological analysis. Methods During a 5-month period, all patients admitted to a medical ICU were tested for ESBL-E carriage. A rectal swab was performed at admission and then twice a week until discharge or death. ESBL-E strains were analyzed according to antibiotic susceptibility pattern, rep-PCR (repetitive-element Polymerase chain reaction) chromosomal analysis, and plasmid PCR (Polymerase chain reaction) analysis of ESBL genes. Patient-to-patient transmission was deemed likely when 2 identical strains were found in 2 patients hospitalized simultaneously in the ICU. Results Among the 309 patients assessed for ESBL-E carriage on admission, 25 were found to carry ESBL-E (importation rate: 8 %). During follow-up, acquisition was observed among 19 of them (acquisition rate: 6.5 %). Using the multimodal microbiological approach, we found only one case of likely patient-to-patient ESBL-E transmission. Conclusions In unselected ICU patients, we found rather low rates of ESBL-E referred and acquired cases. Only 5 % of acquisitions appeared to be related to patient-to-patient transmission. These data highlight the importance of jointly analyzing phenotypic profile and molecular data to discriminate strains of ESBL-E. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1489-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mikael Alves
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Astrid Lemire
- Service de Microbiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Dominique Decré
- Service de Microbiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Dimitri Margetis
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Naïke Bigé
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Claire Pichereau
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Hafid Ait-Oufella
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France
| | - Jean-Luc Baudel
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Georges Offenstadt
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France.,Inserm-UPMC UMR S 1136, Paris, France
| | - Bertrand Guidet
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France.,Université Pierre et Marie Curie-Paris 6, Paris, France.,Inserm-UPMC UMR S 1136, Paris, France
| | - Frédéric Barbut
- Service de Microbiologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Eric Maury
- Service de Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, 75012, Paris, France. .,Université Pierre et Marie Curie-Paris 6, Paris, France. .,Inserm-UPMC UMR S 1136, Paris, France.
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18
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Wong H, Eso K, Ip A, Jones J, Kwon Y, Powelson S, de Grood J, Geransar R, Santana M, Joffe AM, Taylor G, Missaghi B, Pearce C, Ghali WA, Conly J. Use of ward closure to control outbreaks among hospitalized patients in acute care settings: a systematic review. Syst Rev 2015; 4:152. [PMID: 26546048 PMCID: PMC4636845 DOI: 10.1186/s13643-015-0131-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Though often used to control outbreaks, the efficacy of ward closure is unclear. This systematic review sought to identify studies defining and describing ward closure in outbreak control and to determine impact of ward closure as an intervention on outbreak containment. METHODS We searched these databases with no language restrictions: MEDLINE, 1946 to 7 July 2014; EMBASE, 1974 to 7 July 2014; CINAHL, 1937 to 8 July 2014; and Cochrane Database of Systematic Reviews, 2005 to May 2014. We also searched the following: IndMED; LILACS; reference lists from retrieved articles; conference proceedings; and websites of the CDCP, the ICID, and the WHO. We included studies of patients hospitalized in acute care facilities; used ward closure as a control measure; used other control measures; and discussed control of the outbreak(s) under investigation. A component approach was used to assess study quality. RESULTS We included 97 English and non-English observational studies. None included a controlled comparison between ward closure and other interventions. We found that ward closure was often used as part of a bundle of interventions but could not determine its direct impact separate from all the other interventions whether used in parallel or in sequence with other interventions. We also found no universal definition of ward closure which was widely accepted. CONCLUSIONS With no published controlled studies identified, ward closure for control of outbreaks remains an intervention that is not evidence based and healthcare personnel will need to continue to balance the competing risks associated with its use, taking into consideration the nature of the outbreak, the type of pathogen and its virulence, mode of transmission, and the setting in which it occurs. Our review has identified a major research gap in this area.
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Affiliation(s)
- Holly Wong
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Katherine Eso
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Ada Ip
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Jessica Jones
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Yoojin Kwon
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Susan Powelson
- Health Sciences Library, Libraries and Cultural Resources, University of Calgary, HSC 1450, Health Sciences Centre, 3330 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4N1
| | - Jill de Grood
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Rose Geransar
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Maria Santana
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - A Mark Joffe
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Geoffrey Taylor
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2D3.05 WMC, Edmonton, Alberta, Canada, T6G 2B7
| | - Bayan Missaghi
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - Craig Pearce
- Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9
| | - William A Ghali
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6
| | - John Conly
- W21C Research and Innovation Centre, Cumming School of Medicine, University of Calgary, GD01 TRW Building, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Infection Prevention and Control, Alberta Health Services, #303 CSC, 10240 Kingsway, Edmonton, Alberta, Canada, T5H 3V9. .,Department of Medicine, Cumming School of Medicine, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Snyder Institute for Chronic Diseases, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,Department of Community Health Sciences, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6. .,O'Brien Institute for Public Health, 3280 Hospital Drive NW, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada, T2N 4Z6.
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19
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Goodman KE, Simner PJ, Tamma PD, Milstone AM. Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae (CRE). Expert Rev Anti Infect Ther 2015; 14:95-108. [PMID: 26535959 DOI: 10.1586/14787210.2016.1106940] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) defines carbapenem-resistant Enterobacteriaceae (CRE) based upon a phenotypic demonstration of carbapenem resistance. However, considerable heterogeneity exists within this definitional umbrella. CRE may mechanistically differ by whether they do or do not produce carbapenemases. Moreover, patients can acquire CRE through multiple pathways: endogenously through antibiotic selective pressure on intestinal microbiota, exogenously through horizontal transmission or through a combination of these factors. Some evidence suggests that non-carbapenemase-producing CRE may be more frequently acquired by antibiotic exposure and carbapenemase-producing CRE via horizontal transmission, but definitive data are lacking. This review examines types of CRE resistance mechanisms, antibiotic exposure and horizontal transmission pathways of CRE acquisition, and the implications of these heterogeneities to the development of evidence-based CRE healthcare epidemiology policies. In our Expert Commentary & Five-Year View, we outline specific nosocomial CRE knowledge gaps and potential methodological approaches for their resolution.
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Affiliation(s)
- K E Goodman
- a Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - P J Simner
- b Department of Pathology, Division of Medical Microbiology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - P D Tamma
- a Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Department of Pediatrics, Division of Pediatric Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - A M Milstone
- a Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Department of Pediatrics, Division of Pediatric Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,d Department of Hospital Epidemiology and Infection Control , The Johns Hopkins Hospital , Baltimore , MD , USA
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20
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Hendrik TC, Voor in ‘t holt AF, Vos MC. Clinical and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella spp.: A Systematic Review and Meta-Analyses. PLoS One 2015; 10:e0140754. [PMID: 26485570 PMCID: PMC4617432 DOI: 10.1371/journal.pone.0140754] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/30/2015] [Indexed: 12/30/2022] Open
Abstract
Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-analysis study. The random-effects meta-analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-to-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp.
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Affiliation(s)
- Tirza C. Hendrik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F. Voor in ‘t holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C. Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- * E-mail:
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21
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Zhang H, Zhou Y, Guo S, Chang W. Prevalence and characteristics of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae isolated from rural well water in Taian, China, 2014. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:11488-11492. [PMID: 25821088 DOI: 10.1007/s11356-015-4387-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/16/2015] [Indexed: 06/04/2023]
Abstract
The production of extended-spectrum beta-lactamase (ESBL) is one of the major antimicrobial resistance mechanisms in Enterobacteriaceae, and the increasing number of ESBL-producing Enterobacteriaceae isolated from water environments has posed a serious threat to the public health. The study aimed to analyze prevalence and characterization of ESBL-producing Enterobacteriaceae from rural well waters in Taian, China. A total of 10 isolates expressing an ESBL phenotype, including 9 Escherichia coli (E. coli) and 1 Klebsiella pneumoniae (K. pneumoniae) was obtained from 4 (4%) out of the 100 sampled wells. ESBL genotype revealed that 9 expressed CTX-M-15 and 1 produced CTX-M-27. Five out of 8 ESBL-producing E. coli expressing CTX-M-15 belonged to ST10, which are mostly detected from human feces in China. Importantly, the only strain of CTX-M-27-producing E. coli belonged to multi-locus sequence type B2:131 (ST131), which may be related with severe infection in humans and animals.
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Affiliation(s)
- Hongna Zhang
- College of Animal Science and Technology, Shandong Agricultural University, Daizong Street 61, Taian, 271000, China,
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22
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Mehrad B, Clark NM, Zhanel GG, Lynch JP. Antimicrobial resistance in hospital-acquired gram-negative bacterial infections. Chest 2015; 147:1413-1421. [PMID: 25940252 DOI: 10.1378/chest.14-2171] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Aerobic gram-negative bacilli, including the family of Enterobacteriaceae and non-lactose fermenting bacteria such as Pseudomonas and Acinetobacter species, are major causes of hospital-acquired infections. The rate of antibiotic resistance among these pathogens has accelerated dramatically in recent years and has reached pandemic scale. It is no longer uncommon to encounter gram-negative infections that are untreatable using conventional antibiotics in hospitalized patients. In this review, we provide a summary of the major classes of gram-negative bacilli and their key mechanisms of antimicrobial resistance, discuss approaches to the treatment of these difficult infections, and outline methods to slow the further spread of resistance mechanisms.
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Affiliation(s)
- Borna Mehrad
- Division of Pulmonary and Critical Care Medicine and The Carter Center for Immunology, University of Virginia, Charlottesville, VA
| | - Nina M Clark
- Division of Infectious Diseases, Department of Medicine, Loyola University, Maywood, IL
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Joseph P Lynch
- Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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Eida M, Nasser M, El-Maraghy N, Azab K. Pattern of hospital-acquired pneumonia in Intensive Care Unit of Suez Canal University Hospital. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2015. [DOI: 10.1016/j.ejcdt.2015.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Calbo E, Garau J. The changing epidemiology of hospital outbreaks due to ESBL-producing Klebsiella pneumoniae: the CTX-M-15 type consolidation. Future Microbiol 2015; 10:1063-75. [DOI: 10.2217/fmb.15.22] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Klebsiella pneumoniae is responsible for a large number of hospital outbreaks. In the 1990s, there were clonal epidemics, affecting mostly intensive care patients, which carried SHV and TEM enzyme types. With the advent of CTX-M-15 enzymes in the 2000, plasmids encoding multiple extended-spectrum β-lactamase (ESBL) types were described and, frequently, nosocomial outbreaks reported polyclonal dissemination and involved multiple Enterobacteriaceae. Worryingly, the interface between community and hospital is becoming blurred, and there is increasing evidence for the presence of ESBL-producing K. pneumoniae in the community. Furthermore, carbapenem resistance is increasingly reported in ESBL-producing K. pneumoniae strains. Infection control measures and stewardship programs are vital weapons in controlling the pandemic evolution of multidrug-resistant K. pneumoniae.
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Affiliation(s)
- Esther Calbo
- Service of Internal Medicine, Infectious Disease Unit, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona, Spain
| | - Javier Garau
- Service of Internal Medicine, Infectious Disease Unit, Hospital Universitari Mútua de Terrassa, Plaza Dr Robert 5, 08221 Terrassa, Barcelona, Spain
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Zhang H, Zhou Y, Guo S, Chang W. Multidrug resistance found in extended-spectrum beta-lactamase-producing Enterobacteriaceae from rural water reservoirs in Guantao, China. Front Microbiol 2015; 6:267. [PMID: 25873918 PMCID: PMC4379920 DOI: 10.3389/fmicb.2015.00267] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Accepted: 03/18/2015] [Indexed: 01/16/2023] Open
Abstract
Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae have been isolated from humans and animals across the world. However, data on prevalence of ESBL-producing Enterobacteriaceae from rural water reservoirs is limited. This study aimed to isolate and characterize ESBL-producing Enterobacteriaceae in rural water reservoirs in Guantao, China. ESBL-producing Enterobacteriaceae were found in 5 (16.7%) of 30 sampled rural water reservoirs. Sixty-six individual isolates expressing an ESBL phenotype were obtained in the present study. Species identification showed that 42 representatives of Escherichia coli, 17 Klebsiella pneumoniae, 4 Raoultella planticola, and 3 Enterobacter cloacae. Twenty isolates contained a single bla gene, including CTX-M (17 strains), TEM (2 strains), and SHV (1 strain). Forty-six isolates contained more than one type of beta-lactamase genes. ESBL-producing Enterobacteriaceae isolated in this study were all multidrug resistant. These findings indicated that the serious contamination of ESBL-producing Enterobacteriaceae in rural water reservoirs existed in Guantao, China.
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Affiliation(s)
- Hongna Zhang
- College of Animal Science and Technology, Shandong Agricultural University , Taian, China
| | - Yufa Zhou
- College of Animal Science and Technology, Shanxi Agricultural University , Taigu, China ; Animal Husbandry Bureau of Daiyue District , Taian, China
| | - Shuyuan Guo
- College of Animal Science and Technology, Shandong Agricultural University , Taian, China
| | - Weishan Chang
- College of Animal Science and Technology, Shandong Agricultural University , Taian, China
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Rodriguez-Villalobos H, Glupczynski Y. Emergence and dissemination of multi-resistant Gram negative Enterobacteriaceae: lessons to be learnt from local and national surveillance programs in Belgium. Acta Clin Belg 2015; 70:1-10. [PMID: 25370895 DOI: 10.1179/2295333714y.0000000034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Infections caused by multi drug resistant bacteria (MDRB) constitutes an international health care problem. Since the year 2000, a longitudinal surveillance programme (LSP) and two multicentric surveys (100 hospitals, 826 isolates) were performed to monitor the emergence of MDRB in Belgium. The implementation of a LSP detected the emergence and spread of new types of ESBLs (CTX-M), mostly among community associated E. coli in the setting of a university hospital several years before the large spread and recognition in Belgium of a pathogenic E. coli CTX-M-15 (B2-O25:H4-ST131) pandemic clone (found in extra-intestinal virulent strains). This finding supports the progressive increase in Belgium of systemic infections including UTI caused by MDRB with limited therapeutical options. The real burden of the problem remains however, difficult to estimate in the absence of any surveillance network in Belgium to monitor the epidemiology of antimicrobial resistance in the community. The current Belgian national recommendations for the detection, surveillance, prevention and control of epidemics by ESBL-producing organisms and possibly other MDRBs (eg: Carbapenemase producing Enterobacteriaceae [CPE]) must be updated taking into accounts these new elements. A global coordinated network for antimicrobial surveillance resistance gathering experts (e.g: public health epidemiologists, representative of the national reference centres of antimicrobial resistance, field experts in infection control, infectious disease specialists, other clinicians and general practitioners) must be urgently implemented, including the longitudinal analysis of resistance in different ecosystems (human, animal, water and food).
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Affiliation(s)
- H. Rodriguez-Villalobos
- Université Catholique de Louvain, Institut de recherche expérimentale et Clinique, p�le de microbiologie, Brussels, Belgium
- Laboratoire de microbiologie, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Y. Glupczynski
- National Reference Centre for Monitoring of Antimicrobial Resistance in Gram-negative bacteria, CHU Dinant-Godinne
- UCL Namur, Yvoir, Belgium
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Abstract
The impact of disease outbreaks continues to increase globally. As frontline staff, critical care nurses (CCNs) are more likely to be confronted with the need to care for affected patients. With different pathological diseases emerging, CCNs play an integral role in disease outbreaks. The advanced skill set of CCNs is pivotal in the management and care of patients during an outbreak. Lack of planning and preparation before disease outbreaks leads to detrimental patient outcomes. Panic, chaos, and fear for personal safety cause stress and anxiety for unprepared nurses. However, this problem can be resolved. Comprehensive planning, training, and education can better prepare intensive care unit nurses for disease outbreaks. This article reviews some of the current literature on intensive care unit nurse preparedness for disease outbreaks in the United States. This article also offers strategies that may be used to better prepare CCNs for disease outbreaks.
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Biehl LM, Schmidt-Hieber M, Liss B, Cornely OA, Vehreschild MJGT. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients – Review of the literature from a clinical perspective. Crit Rev Microbiol 2014; 42:1-16. [DOI: 10.3109/1040841x.2013.875515] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lena M. Biehl
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany,
| | - Martin Schmidt-Hieber
- Klinik für Hämatologie, Onkologie und Tumorimmunologie, HELIOS Klinikum Berlin Buch, Berlin, Germany,
| | - Blasius Liss
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany,
| | - Oliver A. Cornely
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany,
- German Centre for Infection Research at Cologne, Germany, and
- Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN1106, and Cologne Excellence Cluster on Cellular Stress Response in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Maria J. G. T. Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany,
- German Centre for Infection Research at Cologne, Germany, and
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Knudsen JD, Andersen SE. A multidisciplinary intervention to reduce infections of ESBL- and AmpC-producing, gram-negative bacteria at a University Hospital. PLoS One 2014; 9:e86457. [PMID: 24466106 PMCID: PMC3900527 DOI: 10.1371/journal.pone.0086457] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 12/15/2013] [Indexed: 11/18/2022] Open
Abstract
In response to a considerable increase in the infections caused by ESBL/AmpC-producing Klebsiella pneumonia in 2008, a multidisciplinary intervention, with a main focus on antimicrobial stewardship, was carried out at one university hospital. Four other hospitals were used as controls. Stringent guidelines for antimicrobial treatment and prophylaxis were disseminated throughout the intervention hospital; cephalosporins were restricted for prophylaxis use only, fluoroquinolones for empiric use in septic shock only, and carbapenems were selected for penicillin-allergic patients, infections due to ESBL/AmpC-producing and other resistant bacteria, in addition to their use in severe sepsis/septic shock. Piperacillin-tazobactam ± gentamicin was recommended for empiric treatments of most febrile conditions. The intervention also included education and guidance on infection control, as well as various other surveillances. Two year follow-up data on the incidence rates of patients with selected bacterial infections, outcomes, and antibiotic consumption were assessed, employing before-and-after analysis and segmented regression analysis of interrupted time series, using the other hospitals as controls. The intervention led to a sustained change in antimicrobial consumption, and the incidence of patients infected with ESBL-producing K. pneumoniae decreased significantly (p<0.001). The incidences of other hospital-associated infections also declined (p’s<0.02), but piperacillin-tazobactam-resistant Pseudomonas aeruginosa and Enterococcus faecium infections increased (p’s<0.033). In wards with high antimicrobial consumption, the patient gut carrier rate of ESBL-producing bacteria significantly decreased (p = 0.023). The unadjusted, all-cause 30-day mortality rates of K. pneumoniae and E. coli were unchanged over the four-year period, with similar results in all five hospitals. Although not statistically significant, the 30-day mortality rate of patients with ESBL-producing K. pneumoniae decreased, from 35% in 2008–2009, to 17% in 2010–2011. The two-year follow-up data indicated that this multidisciplinary intervention led to a statistically significant decrease in the incidence of ESBL/AmpC-resistant K. pneumoniae infections, as well as in the incidences of other typical hospital-associated bacterial infections.
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Affiliation(s)
- Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
- Infection Control Organisation, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen NV, Denmark
- * E-mail:
| | - Stig Ejdrup Andersen
- Department of Clinical Pharmacology, Copenhagen University Hospital, Bispebjerg Hospital, Copenhagen NV, Denmark
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Tacconelli E, Cataldo M, Dancer S, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodríguez-Baño J, Singh N, Venditti M, Yokoe D, Cookson B. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1:1-55. [DOI: 10.1111/1469-0691.12427] [Citation(s) in RCA: 527] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 09/29/2013] [Accepted: 10/06/2013] [Indexed: 01/04/2023]
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Bourigault C, Corvec S, Bemer P, Juvin ME, Guillouzouic A, Crémet L, Reynaud A, Leprince C, Lepelletier D. [Impact of enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBLE) incidence increasing on barrier precautions implementation in a university hospital]. PATHOLOGIE-BIOLOGIE 2013; 61:217-222. [PMID: 22841390 DOI: 10.1016/j.patbio.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 06/18/2012] [Indexed: 06/01/2023]
Abstract
AIM OF THE STUDY The French national surveillance program of multidrug-resistant bacteria (MDR) shows an increase of enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBLE) incidence. The objectives of this study were to assess: the incidence of EBLSE in a large French university hospital between 2005 and 2010, and the difference of barrier precautions implementation between ESBL and other MDR. METHODS The ESBLE incidence measure used data from the laboratory of bacteriology. The application of isolation and barrier precautions was analyzed from the MRB national surveillance data over a 3-year period from 2006 to 2008. Data were entered and analyzed using Epi Info software. The Chi(2) test was used for the comparison of proportions. RESULTS The overall incidence of ESBLE was significantly higher in 2010 than in 2005 (0.20/1000 patients-days vs 0.03/1000 patients-days, respectively) (P<0.001). The same was observed for Escherichia coli incidence with rates ranging from 0.02/1000 patients-days in 2005 to 0.15/1000 patients-days in 2010. Isolation precautions for patients with EBLSE were applied in relation for most patients with MRB (ESBLE vs others), without significant difference. CONCLUSION The surveillance programme of MRB showed a significant increase of ESBLE, especially for E. coli. Isolation and barrier precautions were used for most patients with MRB, including ESBLE.
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Affiliation(s)
- C Bourigault
- Unité de gestion du risque infectieux, service de bactériologie-hygiène, Le Tourville, 5, rue du Pr-Yves-Boquien, 44093 Nantes cedex 01, France.
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Outbreak caused by an ertapenem-resistant, CTX-M-15-producing Klebsiella pneumoniae sequence type 101 clone carrying an OmpK36 porin variant. J Clin Microbiol 2013; 51:3176-82. [PMID: 23850951 DOI: 10.1128/jcm.01244-13] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Although numerous studies have documented outbreaks of carbapenem-resistant Klebsiella pneumoniae (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum β-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal K. pneumoniae strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant K. pneumoniae isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining β-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the blaCTX-M-15 gene on a conjugative 100-kb plasmid, disruption in the expression of the ompK35 gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental K. pneumoniae isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak.
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Liu YP, Liang SR, Guo ZH, Li ST, Li J. Antibiotic application in cirrhotic patients with extended-spectrum b-lactamase producing E. coli infection. Shijie Huaren Xiaohua Zazhi 2013; 21:1178-1184. [DOI: 10.11569/wcjd.v21.i13.1178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the antibiotic application in cirrhotic patients with extended-spectrum b-lactamase (ESBL)-producing Escherichia coli (E. coli) infection.
METHODS: The data for cirrhotic inpatients with ESBL-producing E. coli infection from 2006 to 2011 were collected, and demographic profiles, clinical characteristics, and efficacy of anti-infection treatment were retrospectively analyzed.
RESULTS: A total of 911 infections were found among 4065 cirrhotic patients, of whom 455 were culture-positive. Fifty cirrhotic patients had ESBL-producing E. coli infection. Quinolones (mainly levofloxacin) were primarily used in 23 (46%) cases, third-generation cephalosporins in 16 (32%) cases, and β-lactam/β-lactamase inhibitors in 11 (22%) cases. These three groups of patients showed no significant difference in the clinical outcome (P > 0.05). A switch to another antibiotic was found in 28 (56%) cases. Twenty-two cases (56%) responded to antibiotic therapy, 13 cases (26%) did not respond, and nine cases (18%) died. Compared to the death group, the survival group had significantly different Child-Pugh A (P < 0.05) and initial use of quinolones (P < 0.05). Compared to the non-response group, the response group had significantly different Child-Pugh C (P < 0.05) and bacteremia (P < 0.05). Neither hepatic encephalopathy nor upper gastrointestinal hemorrhage differed significantly between the survival and death group.
CONCLUSION: The efficacy of initial use of empirical antibiotics is very low in cirrhotic patients with ESBL-producing E. coli infection. Compared to third-generation cephalosporins, quinolones are more effective as the first treatment. Liver function-protecting support therapy should be strengthened when treating such infection. Accurate bacterial identification and antimicrobial susceptibility test should be performed to provide timely targeted therapy.
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Lowe CF, Katz K, McGeer AJ, Muller MP. Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. PLoS One 2013; 8:e62678. [PMID: 23638132 PMCID: PMC3637447 DOI: 10.1371/journal.pone.0062678] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 03/24/2013] [Indexed: 11/18/2022] Open
Abstract
Objective We hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates. Design Retrospective cohort study. Setting 12 hospitals (6 screening and 6 non-screening) in Toronto, Canada. Patients All adult inpatients with an ESBL-E positive culture collected from 2005–2009. Methods Cases were defined as hospital-onset (HO) or community-onset (CO) if cultures were positive after or before 72 hours. Efficacy of screening in reducing HO-ESBL-E incidence was assessed with a negative binomial model adjusting for study year and CO-ESBL-E incidence. The accuracy of the HO-ESBL-E definition was assessed by re-classifying HO-ESBL-E cases as confirmed nosocomial (negative admission screen), probable nosocomial (no admission screen) or not nosocomial (positive admission screen) using data from the screening hospitals. Results There were 2,088 ESBL-E positive patients and incidence of ESBL-E rose from 0.11 to 0.42 per 1,000 inpatient days between 2005 and 2009. CO-ESBL-E incidence was similar at screening and non-screening hospitals but screening hospitals had a lower incidence of HO-ESBL-E in all years. In the negative binomial model, screening was associated with a 49.1% reduction in HO-ESBL-E (p<0.001). A similar reduction was seen in the incidence of HO-ESBL-E bacteremia. When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases. Conclusions Admission screening for ESBL-E is associated with a reduced incidence of HO-ESBL-E. Controlled, prospective studies of admission screening for ESBL-E should be a priority.
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Affiliation(s)
- Christopher F. Lowe
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Deparment of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
| | - Allison J. McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Matthew P. Muller
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
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Lynch JP, Clark NM, Zhanel GG. Evolution of antimicrobial resistance among Enterobacteriaceae (focus on extended spectrum β-lactamases and carbapenemases). Expert Opin Pharmacother 2013; 14:199-210. [DOI: 10.1517/14656566.2013.763030] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lowe C, Willey B, O'Shaughnessy A, Lee W, Lum M, Pike K, Larocque C, Dedier H, Dales L, Moore C, McGeer A. Outbreak of extended-spectrum β-lactamase-producing Klebsiella oxytoca infections associated with contaminated handwashing sinks(1). Emerg Infect Dis 2013; 18:1242-7. [PMID: 22841005 PMCID: PMC3414015 DOI: 10.3201/eid1808.111268] [Citation(s) in RCA: 116] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Sinks are a potential reservoir for environment-to-patient and patient-to-patient transmission. Klebsiella oxytoca is primarily a health care–associated pathogen acquired from environmental sources. During October 2006–March 2011, a total of 66 patients in a hospital in Toronto, Ontario, Canada, acquired class A extended-spectrum β-lactamase–producing K. oxytoca with 1 of 2 related pulsed-field gel electrophoresis patterns. New cases continued to occur despite reinforcement of infection control practices, prevalence screening, and contact precautions for colonized/infected patients. Cultures from handwashing sinks in the intensive care unit yielded K. oxytoca with identical pulsed-field gel electrophoresis patterns to cultures from the clinical cases. No infections occurred after implementation of sink cleaning 3×/day, sink drain modifications, and an antimicrobial stewardship program. In contrast, a cluster of 4 patients infected with K. oxytoca in a geographically distant medical ward without contaminated sinks was contained with implementation of active screening and contact precautions. Sinks should be considered potential reservoirs for clusters of infection caused by K. oxytoca.
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Murphy RJ. Preventing multidrug-resistant gram-negative organisms in surgical patients. AORN J 2013; 96:315-29. [PMID: 22935259 DOI: 10.1016/j.aorn.2012.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 01/30/2012] [Accepted: 04/22/2012] [Indexed: 10/28/2022]
Abstract
Multidrug-resistant gram-positive infections have consumed the attention of health care organizations as well as the media, but recently multidrug-resistant gram-negative organisms (MDR-GNOs) have become more and more prevalent. Limited treatment options are available for MDR-GNO infections; thus, prevention is key. Patients who are at high risk for developing infections must be identified, and specialized prevention interventions must be developed for their care. Surgical patients are one subset of patients at high risk for developing MDR-GNOs. Advanced practice nurses must support nurses and other health care personnel in preventing MDR-GNO infections. Education should include active surveillance, contact precautions, cohorting patients and staff members, unit closures, reinforced hand hygiene practices, and environmental cleaning tailored to the care of surgical patients in regard to their preoperative, intraoperative, and postoperative care.
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Carpentier M, Appere V, Saliou P, de Tinteniac A, Floch H, Le Gall F, Cosse M, El Bouyousfi M, Baron R, Boles JM, Jourdain S, Lejeune B, Nancy B, Prat G, Tande D, Virmaux M, Wargnier JP, Garlantézec R. Outbreak of extended spectrum beta-lactamase-producing Klebsiella pneumoniae in an intensive care unit (Brest). Med Mal Infect 2012; 42:501-9. [PMID: 22975075 DOI: 10.1016/j.medmal.2012.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/05/2012] [Accepted: 07/24/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION We had for aim to describe control and investigation of an outbreak caused by a strain of Extended spectrum beta-lactamase producing Klebsiella pneumoniae in intensive care units of the Brest teaching hospital. PATIENTS AND METHOD The case definition was a patient infected by or carrying the epidemic strain. Control measures and investigations are presented. A case-control study was conducted in the surgical intensive care unit. Each case was matched with two controls based on admission times in the unit. The study focused on diagnostic and therapeutic procedures, and potential contacts with healthcare workers, in this context of cross transmission. RESULTS Between February and May 2011, nine cases were reported in the surgical ICU and two in the medical ICU. Eighteen controls were matched with the nine surgical ICU cases. Several factors were found to be statistically associated with infection or colonization by the epidemic strain: the surgical block in which patients had been operated and the ward of first hospitalization; the number of trans-esophageal and trans-thoracic echocardiographies, of central venous catheter insertions, and of surgical operations; intubation. The total number of invasive procedures was also found to be statistically higher among cases. CONCLUSION This study identified factors associated with colonization or infection by the epidemic strain. These factors might have been involved in the transmission tree, and be vulnerable elements for the prevention of nosocomial infections and colonisations, and their epidemic spread.
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Affiliation(s)
- M Carpentier
- Équipe opérationnelle d'hygiène, CHRU de Brest, Brest, France.
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Hilty M, Betsch BY, Bögli-Stuber K, Heiniger N, Stadler M, Küffer M, Kronenberg A, Rohrer C, Aebi S, Endimiani A, Droz S, Mühlemann K. Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin Infect Dis 2012; 55:967-75. [PMID: 22718774 PMCID: PMC3436924 DOI: 10.1093/cid/cis581] [Citation(s) in RCA: 166] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transmission of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae in households outweighs nosocomial dissemination in the non-outbreak setting. Importation of ESBL producers into the hospitals is as frequent as transmission during hospital stay. ESBL–Klebsiella pneumoniae might be more efficiently transmitted within the hospital than ESBL–Escherichia coli. Background. Studies about transmission rates of extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae in hospitals and households are scarce. Methods. Eighty-two index patients with new carriage of ESBL-producing Escherichia coli (ESBL-Ec; n = 72) or ESBL-producing Klebsiella pneumoniae (ESBL-Kp; n = 10) and their hospital (n = 112) and household (n = 96) contacts were studied prospectively from May 2008 through September 2010. Isolates were phenotypically and molecularly characterized (sequencing of bla genes, repetitive extragenic palindromic polymerase chain reaction, pulse-field gel electrophoresis, and multilocus sequence typing). Transmission was defined as carriage of a clonally-related ESBL producer with identical blaESBL gene(s) in the index patient and his or her contact(s). Results. CTX-M-15 was the most prevalent ESBL in ESBL-Ec (58%) and ESBL-Kp (70%) in the index patients. Twenty (28%) ESBL-Ec isolates were of the hyperepidemic clone ST131. In the hospital, transmission rates were 4.5% (ESBL-Ec) and 8.3% (ESBL-Kp) and the incidences of transmissions were 5.6 (Ec) and 13.9 (Kp) per 1000 exposure days, respectively. Incidence of ESBL-Kp hospital transmission was significantly higher than that of ESBL-Ec (P < .0001), despite implementation of infection control measures in 75% of ESBL-Kp index patients but only 22% of ESBL-Ec index patients. Detection of ESBL producers not linked to an index patient was as frequent (ESBL-Ec, 5.7%; ESBL-Kp, 16.7%) as nosocomial transmission events. In households, transmission rates were 23% for ESBL-Ec and 25% for ESBL-Kp. Conclusions. Household outweighs nosocomial transmission of ESBL producers. The effect of hospital infection control measures may differ between different species and clones of ESBL producers.
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Affiliation(s)
- Markus Hilty
- Institute for Infectious Diseases, University of Bern, Switzerland
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Rosenberger LH, Riccio LM, Campbell KT, Politano AD, Sawyer RG. Quarantine, isolation, and cohorting: from cholera to Klebsiella. Surg Infect (Larchmt) 2012; 13:69-73. [PMID: 22472002 DOI: 10.1089/sur.2011.067] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Isolation is defined as the separation of persons with communicable diseases from those who are healthy. This public health practice, along with quarantine, is used to limit the transmission of infectious diseases and provides the foundation of current-day cohorting. METHODS Review of the pertinent English-language literature. RESULTS Mass isolation developed during the medieval Black Death outbreaks in order to protect ports from the transmission of epidemics. In the mid-1800s, infectious disease hospitals were opened. It now is clear that isolation and cohorting of patients and staff interrupts the transmission of disease. Over the next century, with the discovery of penicillin and vaccines against many infectious agents, the contagious disease hospitals began to close. Today, we find smaller outbreaks of microorganisms that have acquired substantial resistance to antimicrobial agents. In the resource-limited hospital, a dedicated area or region of a unit may suffice to separate affected from unaffected patients. CONCLUSION Quarantine, or cohorting when patients are infected with the same pathogen, interrupts the spread of infections, just as the contagious disease hospitals did during the epidemics of the 18th and 19th centuries.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
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Freeman JT, Williamson DA, Anderson DJ. When should contact precautions and active surveillance be used to manage patients with multidrug-resistant enterobacteriaceae? Infect Control Hosp Epidemiol 2012; 33:753-6. [PMID: 22669239 DOI: 10.1086/666333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Joshua T Freeman
- Department of Microbiology and Infection Prevention and Control, Auckland City Hospital, Auckland, New Zealand.
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42
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Mansour MGE, Bendary S. Hospital-acquired pneumonia in critically ill children: Incidence, risk factors, outcome and diagnosis with insight on the novel diagnostic technique of multiplex polymerase chain reaction. EGYPTIAN JOURNAL OF MEDICAL HUMAN GENETICS 2012. [DOI: 10.1016/j.ejmhg.2012.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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The epidemiology of the first described carbapenem-resistant Klebsiella pneumoniae outbreak in a tertiary care hospital in Saudi Arabia: how far do we go? Eur J Clin Microbiol Infect Dis 2012; 31:1901-9. [DOI: 10.1007/s10096-011-1519-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 12/13/2011] [Indexed: 11/26/2022]
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Mattner F, Bange FC, Meyer E, Seifert H, Wichelhaus TA, Chaberny IF. Preventing the spread of multidrug-resistant gram-negative pathogens: recommendations of an expert panel of the German Society For Hygiene and Microbiology. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:39-45. [PMID: 22334820 PMCID: PMC3272589 DOI: 10.3238/arztebl.2012.0039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 10/24/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Infections with multidrug-resistant gram-negative bacteria are hard to treat and cause high morbidity and mortality. The direct transmission of such pathogens is well documented, and measures to protect other patients would seem indicated. Nonetheless, evidence-based recommendations are not yet available because of insufficient data from clinical trials. METHODS An expert panel was convened by two sections of the German Society for Hygiene and Microbiology (the permanent committee on general and hospital hygiene and the special committee on infection prevention and antibiotic resistance in hospitals) to review existing data on the epidemiology and diagnostic evaluation of multidrug-resistant gram-negative pathogens. The panel carried out a selective review of the relevant literature, with special attention to national guidelines. RESULTS AND CONCLUSION In this paper, the expert panel presents a definition of multidrug-resistant gram-negative pathogens and recommends measures for presenting the spread of infection from colonized and infected patients in non-outbreak situations. These measures depend on the risk profile of the clinical setting. They are mostly to be considered "expert opinion," rather than "evidence-based."
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Affiliation(s)
- Frauke Mattner
- Institut für Hygiene, Universitätsklinikum Witten-Herdecke, Campus Köln-Merheim
| | - Franz-C Bange
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover
| | - Elisabeth Meyer
- Institut für Hygiene und Umweltmedizin, Charité – Universitätsmedizin Berlin
| | - Harald Seifert
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Köln
| | - Thomas A Wichelhaus
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Goethe-Universität, Frankfurt/Main
| | - Iris F Chaberny
- Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover
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45
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L’isolement en réanimation : intérêts, limites, perspectives. MEDECINE INTENSIVE REANIMATION 2012. [DOI: 10.1007/s13546-011-0425-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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46
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Long-term clinical and economic benefits associated with the management of a nosocomial outbreak resulting from extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. Crit Care Med 2011; 39:2672-7. [DOI: 10.1097/ccm.0b013e31822827e0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Nosocomial outbreak of VIM-1-producing Klebsiella pneumoniae isolates of multilocus sequence type 15: molecular basis, clinical risk factors, and outcome. Antimicrob Agents Chemother 2011; 56:420-7. [PMID: 22005997 DOI: 10.1128/aac.05036-11] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
We study the epidemiology, molecular basis, clinical risk factors, and outcome involved in the clonal dissemination of VIM-1-producing Klebsiella pneumoniae isolates in the hospital setting. All patients infected/colonized by carbapenem-nonsusceptible K. pneumoniae (CNSKP) in 2009 were included. Molecular epidemiology was studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Antibiotic resistance genes were analyzed by PCR and sequencing. Plasmids were studied by PFGE with S1 nuclease digestion and for incompatibility group by a PCR-based replicon typing scheme. Risk factors associated with CNSKP colonization/infection were assessed by an observational case-control study. All 55 patients studied were infected (n = 28) or colonized (n = 27) by VIM-1-producing K. pneumoniae. All but one acquired isolates of a single clone (PFGE cluster 1 [C1], sequence type 15 [ST15]), while another clone (PFGE C2, ST340) was detected in four patients. C1 isolates also produced the new extended-spectrum β-lactamase SHV-134. bla(VIM-1) was carried in a class 1 integron and an untypeable plasmid of ∼50 bp. The number of days that the patient received mechanical ventilation, the use of parenteral nutrition, previous treatment with linezolid, and treatment with extended-spectrum cephalosporins for more than 7 days were detected to be independent risk factors for CNSKP acquisition. The VIM-1-producing K. pneumoniae ST15 clone has a high capacity to spread among intensive care unit patients with severe underlying conditions. A high rate of associated mortality and great difficulty in controlling the spread of this clone, without permanent behavioral changes in the personnel, were observed.
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Rosenberger LH, Hranjec T, Politano AD, Swenson BR, Metzger R, Bonatti H, Sawyer RG. Effective cohorting and "superisolation" in a single intensive care unit in response to an outbreak of diverse multi-drug-resistant organisms. Surg Infect (Larchmt) 2011; 12:345-50. [PMID: 21936667 DOI: 10.1089/sur.2010.076] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cohorting patients in dedicated hospital wards or wings during infection outbreaks reduces transmission of organisms, yet frequently, this may not be feasible because of inadequate capacity, especially in the intensive care unit (ICU). We hypothesized that cohorting isolation patients in one geographic location in a single ICU and using enhanced isolation procedures ("superisolation") can prevent the further spread of highly multi-drug-resistant organisms (MDRO). METHODS Six patients dispersed throughout our Surgical Trauma Burn ICU had infections with carbapenem-resistant, non-clonal gram-negative MDRO, namely Klebsiella pneumoniae, Citrobacter freundii, Stenotrophomonas maltophilia, Aeromonas hydrophilia, Proteus mirabilis, Pseudomonas aeruginosa, and Providencia rettgeri. Five of the six patients also had simultaneous isolation of vancomycin-resistant enterococci (VRE). Under threat of unit closure and after all standard isolation procedures had been enacted, these six patients were moved to the front six beds of the unit, the front entrance was closed, and all traffic was redirected through the back entrance. Nursing staff were assigned to either two isolation or two non-isolation patients. In accordance with the practice of Semmelweis, rounds were conducted so as to end at the rooms of the patients with the most highly-resistant bacterial infections. RESULTS A few months after these interventions, all six patients had been discharged from the ICU (three alive and three dead), and no new cases of infection with any of their pathogens (based on species and antibiogram) or VRE occurred. The mean ICU stay and overall hospital length of stay for these six patients were 78.3 days and 117.2 days respectively, with a mortality rate of 50%. CONCLUSION Cohorting patients to one area and altering work routines to minimize contact with patients with MDRO (essentially designating a "high-risk" zone) may be beneficial in stopping patient-to-patient spread of highly resistant bacteria without the need for a dedicated isolation unit.
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Affiliation(s)
- Laura H Rosenberger
- Department of Surgery, University of Virginia Health System , Charlottesville, Virginia 22908, USA.
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Controlled performance evaluation of the DiversiLab repetitive-sequence-based genotyping system for typing multidrug-resistant health care-associated bacterial pathogens. J Clin Microbiol 2011; 49:3616-20. [PMID: 21813717 DOI: 10.1128/jcm.00528-11] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Fast, reliable, and versatile typing tools are essential to differentiate among related bacterial strains for epidemiological investigation and surveillance of health care-associated infection with multidrug-resistant (MDR) pathogens. The DiversiLab (DL) system is a semiautomated repetitive-sequence-based PCR system designed for rapid genotyping. The DL system performance was assessed by comparing its reproducibility, typeability, discriminatory power, and concordance with those of pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and by assessing its epidemiological concordance on well-characterized MDR bacterial strains (n = 165). These included vanA Enterococcus faecium, extended-spectrum β-lactamase (ESBL)-producing strains of Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, and ESBL- or metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa strains. The DL system showed very good performance for E. faecium and K. pneumoniae and good performance for other species, except for a discrimination index of <95% for A. baumannii and E. coli (93.9% and 93.5%, respectively) and incomplete concordance with MLST for P. aeruginosa (78.6%) and E. coli (97.0%). Occasional violations of MLST assignment by DL types were noted for E. coli. Complete epidemiological concordance was observed for all pathogens, as all outbreak-associated strains clustered in identical DL types that were distinct from those of unrelated strains. In conclusion, the DL system showed good to excellent performance, making it a reliable typing tool for investigation of outbreaks caused by study pathogens, even though it was generally less discriminating than PFGE analysis. For E. coli and P. aeruginosa, MLST cannot be reliably inferred from DL type due to phylogenetic group violation or discordance.
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Nagao M, Iinuma Y, Igawa J, Saito T, Yamashita K, Kondo T, Matsushima A, Takakura S, Takaori-Kondo A, Ichiyama S. Control of an outbreak of carbapenem-resistant Pseudomonas aeruginosa in a haemato-oncology unit. J Hosp Infect 2011; 79:49-53. [PMID: 21722990 DOI: 10.1016/j.jhin.2011.04.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 04/23/2011] [Indexed: 11/16/2022]
Abstract
An outbreak of a multidrug-resistant Pseudomonas aeruginosa producing metallo-β-lactamase (MBLPA) in a haemato-oncology unit was controlled using multidisciplinary interventions. The present study assesses the effects of these interventions by active surveillance of the incidence of MBLPA infection at the 1,240-bed tertiary care Kyoto University Hospital in Kyoto, Japan. Infection control strategies in 2004 included strengthening contact precautions, analysis of risk factors for MBLPA infection and cessation of urine collection. However, new MBLPA infections were identified in 2006, which prompted enhanced environmental cleaning, routine active surveillance, and restricting carbapenem usage. Between 2004 and 2010, 17 patients in the unit became infected with indistinguishable MBLPA strains. The final five infected patients were found by routine active surveillance, but horizontal transmission was undetectable. The MBLPA outbreak in the haemato-oncology unit was finally contained in 2008.
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Affiliation(s)
- M Nagao
- Department of Infection Control and Prevention, Kyoto University Hospital, Kyoto, Japan.
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