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Success of an Infection Control Program to Reduce the Spread of Carbapenem-Resistant Klebsiella pneumoniae

  • Sandeep Kochar (a1), Timothy Sheard (a2), Roopali Sharma (a3), Alan Hui (a3), Elaine Tolentino (a4), George Allen (a2), David Landman (a1), Simona Bratu (a1), Michael Augenbraun (a1) and John Quale (a1)...

Abstract

Objective.

To assess the effect of enhanced infection control measures with screening for gastrointestinal colonization on limiting the spread of carbapenem-resistant Klebsiella pneumoniae in a New York City hospital endemic for this pathogen.

Design.

Retrospective observational study with pre- and postinterventional phases.

Methods.

Beginning in 2006, a comprehensive infection control program was instituted in a 10-bed medical and surgical intensive care unit at a university-based medical center. In addition to being placed in contact isolation, all patients colonized or infected with carbapenem-resistant gram-negative bacilli, vancomycin-resistant Enterococcus, or methicillin-resistant Staphylococcus aureus were cohorted to one end of the unit. Improved decontamination of hands and environmental surfaces was encouraged. In addition, routine rectal surveillance cultures were screened for the presence of carbapenem-resistant pathogens. The number of patients per quarter with clinical cultures positive for carbapenem-resistant K. pneumoniae was compared during the approximately 2-year periods before and after the intervention.

Results.

The mean number ( ± SD) of new patients per 1,000 patient-days per quarter with cultures yielding carbapenem-resistant K. pneumoniae decreased from 9.7 ± 2.2 before the intervention to 3.7 ± 1.6 after the intervention (P< .001 ). There was no change in the mean number of patient-days or the mean number of patients per quarter with cultures yielding methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, or carbapenem-resistant Acinetobacter baumannii or Pseudomonas aeruginosa after the intervention. There was no association between antibiotic usage patterns and carbapenem-resistant K. pneumoniae.

Conclusions.

The comprehensive intervention that combined intensified infection control measures with routine rectal surveillance cultures was helpful in reducing the incidence of carbapenem-resistant K. pneumoniae in an intensive care unit where strains producing the carbapenemase KPC were endemic.

Copyright

Corresponding author

SUNY Downstate Medical Center, 450 Clarkson Ave., Box 77, Brooklyn, NY 11203) dlandman@downstate.edu)

References

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1.Jacoby, GA, Munoz-Price, LS. The new β-lactamases. N Engl J Med 2005;352:380391.
2.Pitout, JD, Laupland, KB. Extended-spectrum 0-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 2008;8:159166.
3.Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City: a new threat to our antibiotic armamentarium. Arch Intern Med 2005;165:14301435.
4.Queenan, AM, Bush, K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007;20:440458.
5.Marchaim, D, Navon-Venezia, S, Schwaber, MJ, Carmeli, Y. Isolation of imipenem-resistant Enterobacter species: emergence of KPC-2 carbape-nemase, molecular characterization, epidemiology, and outcomes. Antimicrob Agents Chemother 2008;52:14131418.
6.Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29:10991106.
7.Landman, D, Bratu, S, Kochar, S, et al. Evolution of antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae in Brooklyn, NY. J Antimicrob Chemother 2007;60:7882.
8.Landman, D, Quale, JM, Mayorga, D, et al. Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY: the preantibiotic era has returned. Arch Intern Med 2002;162:15151520.
9.Calfee, D, Jenkins, SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol 2008;29:966968.
10.Tenover, FC, Kalsi, RK, Williams, PP, et al. Carbapenem resistance in Klebsiella pneumoniae not detected by automated susceptibility testing. Emerg Infect Dis 2006;12:12091213.
11.Bratu, S, Mooty, M, Nichani, S, et al. Emergence of KPC-possessing Klebsiella pneumoniae in Brooklyn, New York: epidemiology and recommendations for detection. Antimicrob Agents Chemother 2005;49:30183020.
12.Landman, D, Salvani, JK, Bratu, S, Quale, J. Evaluation of techniques for detection of carbapenem-resistant Klebsiella pneumoniae in stool surveillance cultures. J Clin Microbiol 2005;43:56395641.
13.Woodford, N, Tierno, PM, Young, K, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A β-lactamase, KPC-3, in a New York medical center. Antimicrob Agents Chemother 2004;48:47934799.
14.Endimiani, A, Carias, LL, Hujer, AM, et al. Presence of plasmid-mediated quinolone resistance in Klebsiella pneumoniae isolates possessing blaKPC in the United States. Antimicrob Agents Chemother 2008;52:26802682.
15.Castanheira, M, Sader, HS, Deshpande, LM, Fritsche, TR, Jones, RN. Antimicrobial activities of tigecycline and other broad-spectrum antimicrobials tested against serine carbapenemase- and metallo-β-lactamase-producing Enterobacteriaceae: report from the SENTRY Antimicrobial Surveillance Program. Antimicrob Agents Chemother 2008;52:570573.
16.Anderson, KF, Lonsway, DR, Rasheed, JK, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol 2007;45:27232725.
17.Brooks, SE, Walczak, MA, Hameed, R. Are we doing enough to contain Acinetobacter infections? Infect Control Hosp Epidemiol 2000;21:304.

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