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

Infection Control and Hospital Epidemiology - Tập 35 Số 7 - Trang 810-817 - 2014
Kyle B. Enfield1, Nujhat N Huq, Megan F Gosseling, Darla J. Low, Kevin C. Hazen, Denise Toney, Gavin Slitt, Heidi J. Zapata, Heather L Cox, Jessica Lewis, John Kundzins, Amy J. Mathers, Costi D. Sifri
1Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.

Tóm tắt

ObjectiveWe 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-resistantAcinetobacter baumannii(XDR-AB).DesignBefore-after intervention study.SettingFifteen-bed surgical trauma intensive care unit (ICU).MethodsWe 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 ofblaKPCand 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.ResultsThe 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 endemicblaKPCresistance 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.ConclusionsUse 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.

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Tài liệu tham khảo

Tenover, 1995, Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing, J Clin Microbiol, 33, 2233, 10.1128/JCM.33.9.2233-2239.1995

Jung, 2012, Risk factors for multi-drug resistant Acinetobacter baumannii bacteremia in patients with colonization in the intensive care unit, BMC Infect Dis, 10

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.

10.1046/j.1365-2710.2002.00430.x

10.1089/fpd.2006.3.59

10.1128/mBio.00204-11

10.1128/JCM.03240-12

10.1214/aos/1176346056

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.

10.1111/j.1399-3062.2009.00374.x

3. Centers for Disease Control and Prevention. 2012 CRE toolkit: guidance for control of carbapenem-resistance Enterobacteriaceae

4. (CRE). http://www.cdc.gov/hai/organisms/cre/cre-toolkit/. Accessed January 5, 2013.

10.1056/NEJMra0904124

10.1086/671270

10.1093/cid/cir202

10.1128/JCM.02580-12

10.1111/j.1469-0691.2011.03570.x

10.1016/S1473-3099(08)70279-2

10.1086/675603

10.1093/clinids/23.2.329

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Infection Control and Hospital Epidemiology

Tập 35 Số 7

810-817

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