Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy

Abstract

We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010-2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92-0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95-0.97, p <0.0001) significantly decreased over a period of 30 months. After accounting for changes in monthly census and percentage of externally acquired cases (positive at ≤72 h), the average institutional monthly rate of compliance with CRE screening procedures was the only independent variable associated with a declining monthly incidence of CRE colonization (p 0.002). The monthly incidence of CRE carriage was predictive of BSI (p 0.01). Targeted screening and cohorting of CRE carriers and infections, combined with cleaning, education, and antimicrobial stewardship measures, significantly decreased the institutional incidence of CRE BSI and colonization, despite endemically high CRE carriage rates in the region.

Management of KPC-producing Klebsiella pneumoniae infections

“…In another study, the cumulative incidence of KPC-KP BSI and septic shock at 1 year after haematopoietic stem cell transplantation was significantly reduced from 62.5% to 16.6% after the introduction of systematic screening with rectal swabs, contact precautions and early targeted treatment in neutropenic patients with fever with at least two antibiotics [114]. Finally, a multifaceted infection control program was able to reduce both BSI due to CPE and CPE colonization, whereas monthly incidence of CPE carriage was predictive of BSI [115]. Is decolonization a useful strategy in KPC-KP colonized patients?…”

The rapid spread of carbapenem-resistant Enterobacteriaceae

“…Accurate detection methods are important for developing ideal patient treatment options and surveillance of carbapenemases. In a study done between June 2010 to January 2014, an Italian hospital demonstrated that identification of carbapenemases by disk diffusion synergy and quarantine of CRE carriers significantly reduces incidence of high mortality BSIs [Viale 2015]. …”

Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit

“…38,39 On a larger scale, Israel has achieved remarkable nationwide declines in rates of transmission of these organisms, thanks to a centralized infection control program that involves active surveillance and isolation of carriers in all health care facilities. 40 Further prospective studies are needed to better understand the benefits of screening for carbapenem-resistant bacteria in regions with low and high endemicity.…”