Epidemiological surveillance of multidrug‐resistant gram‐negative bacteria in a solid organ transplantation department

Geladari, Anastasia; Κarampatakis, Theodoros; Antachopoulos, Charalampos; Iosifidis, Εlias; Tsiatsiou, Olga; Politi, Lida; Karyoti, Aggeliki; Papanikolaou, Vasilios; Tsakris, Athanassios; Roilides, Emmanuel

doi:10.1111/tid.12686

Cited by 38 publications

(46 citation statements)

References 44 publications

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“…The key outcome measures reported across the studies included consumption of targeted antimicrobials and/ or associated costs 112,113,132,[114][115][116][117]122,123,128,131 , incidence of Clostridium difficile 112,113,[123][124][125]127,[114][115][116][117][119][120][121][122] or incidence and/ resistance rates of Klebsiella pneumoniae 128,129,144,[130][131][132][133][134]137,139,143 as well as risk on other HCAIs 114,121,123,127,130,137,139 . Additional outcomes included containment of an outbreak of the targeted organisms 135,136,138,[140][141][142]…”

Section: Discussionmentioning

confidence: 99%

“…The interventions involved various cadres of professionals namely infectious disease (ID) experts 113,114,124,125,139 , consultants 117,130,139,141,145 , nurses 113,125,140,141,144,145,127,128,130,133,134,[137][138][139] , doctors 116,[123][124][125]137 , physicians 112,113,138,139,141,143,145,115,117,118,122,124,127,128,133 , pharmacists 112,[115][116][117]122,[124]...…”

Section: Interventionsmentioning

confidence: 99%

“…One study involving a flagging system for confirmed cases, isolation precautions, and a carbapenems restriction policy in a 1000-bed tertiary university hospital simply indicated there was a reduction in the use of meropenem 128 patients prospectively in the solid organ transplant (SOT) department. The increase in the incidence of other carbapenem resistant organisms was attributed to the intrahospital transfer of carriers to the SOT department and the subsequent transfer of post-surgical patients to the ICU where they were allegedly colonized by bacteria 137 . There are no studies that reported on the impact of interventions on mortality associated with Klebsiella pneumoniae in healthcare settings.…”

Section: Antimicrobials Usementioning

confidence: 99%

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Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Okeah

Huws

Morrison

2020

Preprint

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Background: According to the European Center for Disease Prevention and Control (ECDC), the EU records an estimated 3.2 million healthcare associated infections (HAIs) and an associated 37,000 deaths annually. A significant proportion of the HAIs burden is attributable to multi-drug resistant pathogens. Infectious diseases remain top on the list of the leading causes of death globally with multi-drug resistant microorganisms (MDROs) playing a significant role. Aims: To assess the breadth of studies on antibiotics stewardship C. diff and Klebsiella pneumoniae in healthcare settings. To identify existing literature on the interventions for reducing healthcare associated C. diff and Klebsiella pneumoniae transmission. Methods: This scoping review was undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols (PRISMA-P) guidelines. The specific databases searched included MEDLINE, PubMed, Web of Science Core Collection, and CINAHL. The process for screening articles and data extraction was undertaken in duplicate by two reviewers. A narrative synthesis of the results is provided. Results: The review included 34 studies (16 studies on Clostridium difficile and 18 articles focussed on Klebsiella pneumoniae). These interventions include Education, Surveillance/Screening, Consultations, Audits, Policies/Protocols, Environmental disinfection, Bundles, Isolation, and Notifications or alerts (ESCAPE-BIN). A study involving screening, alerts, staff education, and antimicrobial protocols recorded a 75% reduction in the use of targeted antimicrobials. The largest absolute reduction in antimicrobial use of 310 DDs/1000PDs was reported from an intervention that involved audits and feedback systems. The highest improvement (95%) in adherence was reported by an intervention involving the use of an infection prevention bundle and an environmental cleaning protocol. Conclusion: Antimicrobial resistance represents a global threat requiring urgent measures to protect lives. Reducing the burden of AMR entails a host of multi-level approaches aimed at curbing transmission of the resistant pathogens, and optimizing the use of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Section: Interventionsmentioning

confidence: 99%

Section: Antimicrobials Usementioning

confidence: 99%

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Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Okeah

Huws

Morrison

2020

Preprint

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“…Understanding the epidemiology and microbiology of MDRO bacterial infections in HT recipients is timely and necessary for identification of risk factors. Male gender, older age, length of hospital stay, admission to intensive care unit, use of post‐transplant hemodialysis, use of invasive devices, prior colonization, and exposure to a variety of antimicrobials have frequently been cited as risk factors for acquisition of MDR or XDR infections among SOT patients . While we can learn from other organ transplant populations, risk factors for MDRO infections specific to HT need to be investigated given the unique nature of the transplant surgical procedure conferring site‐specific risk of infection and differences in microbial flora.…”

Section: Discussionmentioning

confidence: 99%

Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes

Bhatt

Ali

Rana

et al. 2019

Transplant Infectious Dis

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Background Infections secondary to multidrug‐resistant organisms (MDRO) have emerged as a growing problem in solid organ transplantation (SOT). Most of the published data on MDRO infections in SOT pertains to abdominal organ transplantation and data specific to heart transplantation (HT) are limited. Methods This is a retrospective review of HT recipients at our institution from 2011 to 2016; with the aim to investigate the epidemiology, microbiologic spectrum, and outcomes in patients with post‐HT MDRO infections, classified as multidrug‐resistant (MDR), extensively drug‐resistant (XDR), and pandrug‐resistant (PDR) using standardized definitions. Results Of the 149 HT recipients, 82 episodes of bacterial infection were seen in 46 patients (31%) in the year following HT. Thirty (37%) were due to MDR pathogens and 13 (16%) were XDR. The most common gram‐negative MDR pathogens were extended‐spectrum beta‐lactamase (ESBL) Escherichia coli and Klebsiella pneumoniae; while XDR pathogens were most commonly Pseudomonas aeruginosa followed by carbapenem‐resistant Klebsiella pneumoniae. Majority of infection episodes were bloodstream (54, 66%) followed by pulmonary infection (20, 24%). Within a year after transplant, HT recipients with any bacterial infection had significantly higher mortality versus those without infection; and XDR infections were associated with a 26‐fold greater hazard of death on average compared to those without infection (adjusted HR, 26.1; 95% CI, 6.4‐107.0; P < .001). There were no PDR infections. Conclusion Bacterial infections were a significant predictor of 1‐year post‐HT mortality, which was highest among those with XDR infections. This study highlights the burden of MDRO infections in HT recipients and identifies an area of future research.

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“…The use of fluoroquinolone prophylaxis (FP) in endemic settings is a matter of debate, as they result in an increasing prevalence of resistant microorganisms and may reduce the efficacy of subsequent antibacterial treatment [6]. Routine active surveillance cultures (SC) from gastrointestinal tract and contact precautions in colonized patients have proven to be useful in intensive care and solid organ transplantation settings [7,8] but its cost-effectiveness in AML is to be demonstrated [9]. Furthermore, there is no international agreement on how to organize and implement active surveillance control measures for the detection of colonized AML [10].…”

Section: Introductionmentioning

confidence: 99%

The Value of Adding Surveillance Cultures to Fluoroquinolone Prophylaxis in the Management of Multiresistant Gram Negative Bacterial Infections in Acute Myeloid Leukemia

Castañón

Moreno

Verdugo

et al. 2019

JCM

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Multidrug resistant Gram-Negative Bacterial Infections (MR-GNBI) are an increasing cause of mortality in acute myeloid leukemia (AML), compromising the success of antineoplastic therapy. We prospectively explored a novel strategy, including mandatory fluoroquinolone prophylaxis, weekly surveillance cultures (SC) and targeted antimicrobial therapy for febrile neutropenia, aimed to reduce infectious mortality due to MR-GNBI. Over 146 cycles of chemotherapy, cumulative incidence of colonization was 50%. Half of the colonizations occurred in the consolidation phase of treatment. Application of this strategy led to a significant reduction in the incidence of GNB and carbapenemase-producing Klebisella pneumoniae (cpKp) species, resulting in a reduction of infectious mortality (HR 0.35 [95%, CI 0.13–0.96], p = 0.042). In multivariate analysis, fluroquinolone prophylaxis in addition to SC was associated with improved survival (OR 0.55 [95% CI 0.38–0.79], p = 0.001). Targeted therapy for colonized patients did not overcome the risk of death once cpKp or XDR Pseudomonas aeruginosa infections were developed. Mortality rate after transplant was similar between colonized and not colonized patients. However only 9% of transplanted patients were colonized by cpkp. In conclusion, colonization is a common phenomenon, not limited to the induction phase. This strategy reduces infectious mortality by lowering the global incidence of GN infections and the spread of resistant species.

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Epidemiological surveillance of multidrug‐resistant gram‐negative bacteria in a solid organ transplantation department

Abstract: In settings where CR gram-negative bacteria are endemic, colonization and infection rates by these bacteria are high among SOT recipients. Implementation of enhanced ICM in all related units of a hospital, although challenging, reduces colonization rates by CR gram-negative bacteria.

Cited by 38 publications

References 44 publications

Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Antibiotics resistance and mitigation strategies in healthcare settings: A scoping review

Infections due to multidrug‐resistant organisms following heart transplantation: Epidemiology, microbiology, and outcomes

The Value of Adding Surveillance Cultures to Fluoroquinolone Prophylaxis in the Management of Multiresistant Gram Negative Bacterial Infections in Acute Myeloid Leukemia

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