Subsequent carbapenem-resistant Enterobacteriaceae (CRE)–associated infections among hospitalized patients with CRE colonization: Impact of antibiotic use and other factors

2020 ◽  
Vol 41 (9) ◽  
pp. 1084-1089
Author(s):  
Thana Khawcharoenporn ◽  
Wipada Laichuthai
Keyword(s):  
Infection Control ◽  
Antibiotic Use ◽  
Central Line ◽  
Control Measures ◽  
Factors Associated ◽  
Central Line Insertion ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Line Insertion ◽  
Carbapenem Resistant Enterobacteriaceae

AbstractWe demonstrated a 20% rate of subsequent carbapenem-resistant Enterobacteriaceae (CRE)–associated infections among hospitalized CRE carriers. Independent factors associated with the infections were number of colonization sites, central-line insertion, and receiving vancomycin before colonization. These findings underscore the importance of antibiotic stewardship and device-related infection control measures to prevent CRE infections.

scholarly journals Infection Control for a Carbapenem-Resistant Enterobacteriaceae Outbreak in an Advanced Emergency Medical Services Center

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1537
Author(s):  
Yoshiro Sakai ◽  
Kenji Gotoh ◽  
Ryuichi Nakano ◽  
Jun Iwahashi ◽  
Miho Miura ◽  
...  
Keyword(s):  
Infection Control ◽  
Medical Service ◽  
Control Measures ◽  
Infection Control Team ◽  
Partial Closure ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Emergency Medical ◽  
Lactamase Gene ◽  
Carbapenem Resistant Enterobacteriaceae

Background: A carbapenem-resistant Enterobacteriaceae (CRE) outbreak occurred in an advanced emergency medical service center [hereafter referred to as the intensive care unit (ICU)] between 2016 and 2017. Aim: Our objective was to evaluate the infection control measures for CRE outbreaks. Methods: CRE strains were detected in 16 inpatients located at multiple sites. Environmental cultures were performed and CRE strains were detected in 3 of 38 sites tested. Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and detection of β-lactamase genes were performed against 25 CRE strains. Findings: Molecular typing showed the PFGE patterns of two of four Klebsiella pneumoniae strains were closely related and the same MLST (ST2388), and four of five Enterobacter cloacae strains were closely related and same MLST (ST252). Twenty-three of 25 CRE strains harbored the IMP-1 β-lactamase gene and 15 of 23 CRE strains possessed IncFIIA replicon regions. Despite interventions by the infection control team, new inpatients with the CRE strain continued to appear. Therefore, the ICU was partially closed and the inpatients with CRE were isolated, and the ICU staff was divided into two groups between inpatients with CRE and non-CRE strains to avoid cross-contamination. Although the occurrence of new cases dissipated quickly after the partial closure, a few months were required to eradicate the CRE outbreak. Conclusion: Our data suggest that the various and combined measures that were used for infection control were essential in stopping this CRE outbreak. In particular, partial closure to isolate the ICU and division of the ICU staff were effective.

scholarly journals Spread of Carbapenem-Resistant Enterobacteriaceae in a Region, China: How to Control?

2021 ◽  
Author(s):  
Jiansheng Wang ◽  
Changfu Yin ◽  
Weiwei Yang ◽  
Yuanpeng Lv ◽  
Peng Zhao
Keyword(s):  
Infection Control ◽  
Average Length ◽  
Mortality Rates ◽  
Control Measures ◽  
Evidence Based ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Epidemiological Characteristics ◽  
Length Of Hospitalization ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The increasing number of carbapenem-resistant Enterobacteriaceae (CRE) has become a serious problem globally. This study aimed to elucidate their geographically epidemiological characteristics and explore evidence-based infection control measures. Results A total of 930 phenotypically confirmed CRE isolates collected from 19 hospitals were genotypically characterised. K.pneumoniae (KP) and E.coli isolates were 787 (85.17%) and 96 (10.39%) among 924 carbapenemase-producing Enterobacteriaceae (CPE) isolates. Two major carbapenemase genes KPC-2 and NDM in CPE isolates accounted for 84.63% (n = 782) and 13.74% (n = 127). ST11 comprised 86.32% (631/731) of KPC-2 KP isolates. Wzi typing could discriminate ST11 KP clones and precisely track their transmission. Conjugation assays demonstrated that Some KPC-2- and NDM-bearing plasmids could be conjugatively transferred. The transferability was influenced by different STs and different wzis. CRE patients were becoming increasingly younger due to nosocomial CRE acquisition. The average length of hospitalization of these patients showed a downward trend mainly due to significant increases in voluntarily discharged rates and mortality rates. No associations between the rates of antibiotics consumption and CRE prevalence were observed. Evidence-based measures could effectively reduce the prevalence of ST11-wzi209 clone but failed to control the dissemination of ST11-wzi141 KP clone. Conclusions Continued vigilance for the importations should be maintained. Coordinated regional interventions are urgently needed to reduce CRE threat.

Healthcare personnel experiences implementing carbapenem-resistant Enterobacterales infection control measures at a ventilator-capable skilled nursing facility—A qualitative analysis

2021 ◽  
pp. 1-7
Author(s):  
Katharina R. Rynkiewich ◽  
Jinal Makhija ◽  
Mary Carl M. Froilan ◽  
Ellen C. Benson ◽  
Alice Han ◽  
...  
Keyword(s):  
Infection Control ◽  
Multidrug Resistant ◽  
Control Measures ◽  
Healthcare Personnel ◽  
Skilled Nursing ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Resident Care ◽  
Semistructured Interviews ◽  
Self Protection

Abstract Objective: Ventilator-capable skilled nursing facilities (vSNFs) are critical to the epidemiology and control of antibiotic-resistant organisms. During an infection prevention intervention to control carbapenem-resistant Enterobacterales (CRE), we conducted a qualitative study to characterize vSNF healthcare personnel beliefs and experiences regarding infection control measures. Design: A qualitative study involving semistructured interviews. Setting: One vSNF in the Chicago, Illinois, metropolitan region. Participants: The study included 17 healthcare personnel representing management, nursing, and nursing assistants. Methods: We used face-to-face, semistructured interviews to measure healthcare personnel experiences with infection control measures at the midpoint of a 2-year quality improvement project. Results: Healthcare personnel characterized their facility as a home-like environment, yet they recognized that it is a setting where germs were ‘invisible’ and potentially ‘threatening.’ Healthcare personnel described elaborate self-protection measures to avoid acquisition or transfer of germs to their own household. Healthcare personnel were motivated to implement infection control measures to protect residents, but many identified structural barriers such as understaffing and time constraints, and some reported persistent preference for soap and water. Conclusions: Healthcare personnel in vSNFs, from management to frontline staff, understood germ theory and the significance of multidrug-resistant organism transmission. However, their ability to implement infection control measures was hampered by resource limitations and mixed beliefs regarding the effectiveness of infection control measures. Self-protection from acquiring multidrug-resistant organisms was a strong motivator for healthcare personnel both outside and inside the workplace, and it could explain variation in adherence to infection control measures such as a higher hand hygiene adherence after resident care than before resident care.

A National Intervention to Prevent the Spread of Carbapenem-Resistant Enterobacteriaceae in Israeli Post-Acute Care Hospitals

2014 ◽  
Vol 35 (7) ◽  
pp. 802-809 ◽  
Author(s):  
Debby Ben-David ◽  
Samira Masarwa ◽  
Amos Adler ◽  
Hagit Mishali ◽  
Yehuda Carmeli ◽  
...  
Keyword(s):  
Infection Control ◽  
Acute Care ◽  
Acute Care Hospitals ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
Control Intervention ◽  
The Impact ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Post Acute Care

ObjectivePatients hospitalized in post-acute care hospitals (PACHs) constitute an important reservoir of antimicrobial-resistant bacteria. High carriage prevalence of carbapenem-resistant Enterobacteriaceae (CRE) has been observed among patients hospitalized in PACHs. The objective of the study is to describe the impact of a national infection control intervention on the prevalence of CRE in PACHs.DesignA prospective cohort interventional study.SettingThirteen PACHs in Israel.InterventionA multifaceted intervention was initiated between 2008 and 2011 as part of a national program involving all Israeli healthcare facilities. The intervention has included (1) periodic on-site assessments of infection control policies and resources, using a score comprised of 16 elements; (2) assessment of risk factors for CRE colonization; (3) development of national guidelines for CRE control in PACHs involving active surveillance and contact isolation of carriers; and (4) 3 cross-sectional surveys of rectal carriage of CRE that were conducted in representative wards.ResultsThe infection control score increased from 6.8 to 14.0 (P < .001) over the course of the study period. A total of 3,516 patients were screened in the 3 surveys. Prevalence of carriage among those not known to be carriers decreased from 12.1% to 7.9% (P = .008). Overall carrier prevalence decreased from 16.8% to 12.5% (P = .013). Availability of alcohol-based hand rub, appropriate use of gloves, and a policy of CRE surveillance at admission to the hospital were independently associated with lower new carrier prevalence.ConclusionA nationwide infection control intervention was associated with enhanced infection control measures and a reduction in the prevalence of CRE in PACHs.

scholarly journals 510. Exposure Investigation Following a Confirmed Case of Candida auris and Multiple Carbapenemase-Producing Carbapenem-Resistant Organisms

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S247-S247
Author(s):  
Frances Nicholson ◽  
Melanie Curless ◽  
Maggie Schiffhauer ◽  
Sean Zhang ◽  
Patricia Simner ◽  
...  
Keyword(s):  
Infection Control ◽  
Index Patient ◽  
The United States ◽  
Point Prevalence ◽  
Control Measures ◽  
Candida Auris ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Surveillance Cultures ◽  
Routine Surveillance

Abstract Background Co-infections of Candida auris and carbapenemase-producing carbapenem-resistant Gram-negative organisms (CP-CRO) are an increasing global concern and rarely seen in the United States. We report the case of a 59-year-old male, with recent hospitalization in India, admitted to our facility with C. auris isolated from urine and axilla/groin specimens and CP-CRO from five body sites. Methods Travel screening in the emergency department identified a patient at high risk for colonization/infection with multidrug-resistant organisms (MDRO). Contact precautions were initiated. Eight CP-CRO isolates were subsequently identified from clinical and routine surveillance cultures from five separate sites. Of the isolates, seven contained one or more carbapenemase-producing genes detected by Xpert Carba-R assay (Cepheid, Sunnyvale, CA) (Table 1). The microbiology laboratory alerted the infection control department of a presumptive positive C. auris from a clinical urine culture from the same patient. Enhanced mitigation strategies were initiated in regards to cleaning and disinfection. An exposure investigation was also conducted using a point prevalence approach. Surveillance cultures were obtained from inpatients currently admitted to the same unit as the index patient. Axilla/groin specimens were collected for C. auris testing, and rectal specimens were collected for CP-CRO gene testing (CRE Real-Time PCR). Results Eighteen patients in addition to the index patient were hospitalized on the acute medicine unit. One patient refused testing for CP-CRO; therefore, 17 patients were tested for CP-CRO, and 18 patients were tested for C. auris. Neither CP-CRO nor C. auris were recovered from any patient. Conclusion A patient co-infected with C. auris and multiple CP-CRO was identified by clinical and routine surveillance cultures at Johns Hopkins Hospital. Travel screening allowed proactive isolation upon presentation. Enhanced infection control measures were implemented and a point prevalence surveillance study was conducted on the general acute care medicine inpatient unit. No transmission of either C. auris or CP-CRO was detected, likely due in part to rapid identification and strict infection control measures. Disclosures All authors: No reported disclosures.

scholarly journals Prevalence of and environmental factors associated with aerosolised Aspergillus spores at a zoological park

2019 ◽  
Vol 6 (1) ◽  
pp. e000281
Author(s):  
Molly Martony ◽  
Hendrik Nollens ◽  
Melinda Tucker ◽  
Linda Henry ◽  
Todd Schmitt ◽  
...  
Keyword(s):  
Environmental Factors ◽  
Infection Control ◽  
High Efficiency ◽  
Mitigation Strategies ◽  
Control Measures ◽  
Surveillance Systems ◽  
Factors Associated ◽  
Infection Control Measures ◽  
Air Sampler ◽  
Zoological Park

Aspergillus is a significant pathogen in zoological species, although information on environmental variables influencing fungal prevalence in zoological settings are lacking. The objective of the study was to estimate the prevalence of and to identify environmental factors associated with aerosolised Aspergillus spores at a zoological park to advance the understanding of fungal exposure as a first step towards improved mitigation strategies for susceptible animals. Twenty-one locations were sampled for presence of Aspergillus species using the SAS Super 180 Microbial Air Sampler, while twenty-two environmental factors were evaluated every two weeks at SeaWorld of California during two 12-month periods. In each period, the frequency of investigated environmental factors was compared between samples classified as positive or negative for Aspergillus species using logistic regression. Prevalence of Aspergillus was higher (P<0.05) during the second 12-month period (110/525 or 21 per cent), compared with the first period (62/483 or 13 per cent). In both periods, positive Aspergillus samples were associated with indoor sites without high-efficiency particulate air (HEPA) filtration systems and other infection control measures (adjusted OR=4.33 and 5.19, P<0.01) or outdoor sites (adjusted OR=2.50 and3.79, P≤0.05), compared to indoor sites with HEPA filtration systems and other infection control measures, after controlling for season. Burden of airborne Aspergillus can be higher in indoor sites without HEPA filtration systems than in outdoor sites. The use of HEPA filtration systems and other infection control measures can mitigate the burden of Aspergillus. Risk-based surveillance systems that target indoor areas without HEPA filtration systems can be an efficient approach for early detection of high burden of Aspergillus at zoological parks.

scholarly journals The Emergence ofClostridium difficileInfection among Peripartum Women: A Case-Control Study of aC. difficileOutbreak on an Obstetrical Service

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer A. Unger ◽  
Estella Whimbey ◽  
Michael G. Gravett ◽  
David A. Eschenbach
Keyword(s):  
Infection Control ◽  
Case Control Study ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Case Control ◽  
Control Measures ◽  
Multiple Infection ◽  
Infection Control Measures ◽  
Significant Independent Risk Factor ◽  
Control Study

Objective. An outbreak of 20 peripartumClostridium difficileinfections (CDI) occurred on the obstetrical service at the University of Washington Medical Center (UWMC) between April 2006 and June 2007. In this report, we characterize the clinical manifestations, describe interventions that appeared to reduce CDI, and determine potential risk factors for peripartum CDI.Methods. An investigation was initiated after the first three peripartum CDI cases. Based on the findings, enhanced infection control measures and a modified antibiotic regimen were implemented. We conducted a case-control study of peripartum cases and unmatched controls.Results. During the outbreak, there was an overall incidence of 7.5 CDI cases per 1000 deliveries. Peripartum CDI infection compared to controls was significantly associated with cesarean delivery (70% versus 34%;P=0.03), antibiotic use (95% versus 56%;P=0.001), chorioamnionitis (35% versus 5%;P=0.001), and the use of the combination of ampicillin, gentamicin, and clindamycin (50% versus 3%;P<0.001). Use of combination antibiotics remained a significant independent risk factor for CDI in the multivariate analysis.Conclusions. The outbreak was reduced after the implementation of multiple infection control measures and modification of antibiotic use. However, sporadic CDI continued for 8 months after these measures slowed the outbreak. Peripartum women appear to be another population susceptible to CDI.

scholarly journals Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?

2020 ◽  
Vol 9 (9) ◽  
pp. 2744 ◽  
Author(s):  
Beatrice Tiri ◽  
Emanuela Sensi ◽  
Viola Marsiliani ◽  
Mizar Cantarini ◽  
Giulia Priante ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Infection Control ◽  
Prone Position ◽  
Antimicrobial Stewardship ◽  
Control Measures ◽  
Resistant Bacteria ◽  
Infection Control Measures ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Prolonged Contact

The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the “daily-ICU round strategy” and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March–April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4–5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.

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