Hostname: page-component-8448b6f56d-42gr6 Total loading time: 0 Render date: 2024-04-18T17:06:19.426Z Has data issue: false hasContentIssue false
  • English
  • Français

Control of Simultaneous Outbreaks of Carbapenemase-Producing Enterobacteriaceae and Extensively Drug-Resistant Acinetobacter baumannii Infection in an Intensive Care Unit Using Interventions Promoted in the Centers for Disease Control and Prevention 2012 Carbapenemase-Resistant Enterobacteriaceae Toolkit

Published online by Cambridge University Press:  10 May 2016

Kyle B. Enfield ,
Nujhat N. Huq ,
Megan F. Gosseling ,
Darla J. Low ,
Kevin C. Hazen ,
Denise M. Toney ,
Gavin Slitt ,
Heidi J. Zapata ,
Heather L. Cox  and
Jessica D. Lewis
...Show all authors
Kyle B. Enfield
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia
Nujhat N. Huq
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Megan F. Gosseling
Affiliation:
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia
Darla J. Low
Affiliation:
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia
Kevin C. Hazen
Affiliation:
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Denise M. Toney
Affiliation:
Division of Consolidated Laboratory Services, Department of General Services, Commonwealth of Virginia, Richmond, Virginia
Gavin Slitt
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Heidi J. Zapata
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Heather L. Cox
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Jessica D. Lewis
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
John R. Kundzins
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Amy J. Mathers
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Costi D. Sifri*
Affiliation:
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
*
Division of Infectious Diseases and International Health, Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, P.O. Box 800473, Charlottesville, VA 22908 (csifri@virginia.edu).
Get access Rights & Permissions [Opens in a new window]

Extract

Objective

We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).

Design

Before-after intervention study.

Setting

Fifteen-bed surgical trauma intensive care unit (ICU).

Methods

We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.

Results

The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified.

Conclusions

Use of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 810 - 817
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

K.B.E. and N.N.H. contributed equally to this article.

References

1. Peleg, AY, Hooper, DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med 2010;362:1804–1813.CrossRefGoogle ScholarPubMed
2. Karageorgopoulos, DE, Falagas, ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis 2008;8:751–762.CrossRefGoogle ScholarPubMed
3. Gupta, N, Limbago, BM, Patel, JB, Kallen, AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011;53:60–67.CrossRefGoogle ScholarPubMed
4. Centers for Disease Control and Prevention. 2012 CRE toolkit: guidance for control of carbapenem-resistance Enterobacteriaceae (CRE). http://www.cdc.gov/hai/organisms/cre/cre-toolkit/. Accessed January 5, 2013.Google Scholar
5. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.CrossRefGoogle ScholarPubMed
6. Rutala, WA, Weber, DJ; Healthcare Infection Control Practice Advisory Committee (HICPAC). Guideline for disinfection and sterilization in healthcare facilities, 2008. http://www.cdc.gov/hicpac/Disinfection_Sterilization/acknowledg.html. Accessed January 12, 2013.Google Scholar
7. World Health Organization (WHO) Collaborating Centre for Drug Statistics Methodology. ATC/DDD index 2013. http://www.whocc.no/atc_ddd_index/. Accessed November 29, 2013.Google Scholar
8. Mathers, AJ, Cox, HL, Kitchel, B, et al. Molecular dissection of an outbreak of carbapenem-resistant Enterobacteriaceae reveals intergenus KPC carbapenemase transmission through a promiscuous plasmid. MBio 2011;2:e00204–e00211.CrossRefGoogle ScholarPubMed
9. Mathers, AJ, Carroll, J, Sifri, CD, Hazen, KC. Modified Hodge test versus indirect carbapenemase test: prospective evaluation of a phenotypic assay for detection of Klebsiella pneumoniae carbapenemase (KPC) in Enterobacteriaceae . J Clin Microbiol 2013;51:1291–1293.CrossRefGoogle ScholarPubMed
10. Mathers, AJ, Hazen, KC, Carroll, J, et al. First clinical cases of OXA-48-producing carbapenem-resistant Klebsiella pneumoniae in the United States: the “menace” arrives in the new world. J Clin Microbiol 2013;51:680–683.Google ScholarPubMed
11. Mathers, AJ, Poulter, M, Dirks, D, Carroll, J, Sifri, CD, Hazen, KC. Clinical microbiology costs for methods of active surveillance for Klebsiella pneumoniae carbapenemase (KPC) producing Enterobacteriaceae Infect Control Hosp Epidemiol 2014;35(4):350–355.CrossRefGoogle Scholar
12. Ribot, EM, Fair, MA, Gautom, R, et al. Standardization of pulsed-field gel electrophoresis protocols for the subtyping of Escherichia coli O157: H7, Salmonella, and Shigella for PulseNet. Foodborne Pathog Dis 2006;3:59–67.CrossRefGoogle ScholarPubMed
13. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
14. Wagner, AK, Soumerai, SB, Zhang, F, Ross-Degnan, D. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther 2002;27:299–309.CrossRefGoogle ScholarPubMed
15. McCullagh, P. Quasi-likelihood functions. Ann Statist 1983;11:59–67.CrossRefGoogle Scholar
16. Mathers, AJ, Cox, HL, Bonatti, H, et al. Fatal cross infection by carbapenem-resistant Klebsiella in two liver transplant recipients. Transpl Infect Dis 2009;11:257–265.CrossRefGoogle ScholarPubMed
17. Swaminathan, M, Sharma, S, Poliansky Blash, S, et al. Prevalence and risk factors for acquisition of carbapenem-resistant Enterobacteriaceae in the setting of endemicity. Infect Control Hosp Epidemiol 2013;34:809–817.CrossRefGoogle ScholarPubMed
18. Corbella, X, Pujol, M, Ayats, J, et al. Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii . Clin Infect Dis 1996;23:329–334.CrossRefGoogle ScholarPubMed
19. Jung, JY, Park, MS, Kim, SE, et al. Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit. BMC Infect Dis 2012;10:228.Google Scholar