Is cohorting the only solution to control carbapenemase-producing Enterobacteriaceae outbreaks? A single-centre experience

Carbapenemase-producing Enterobacterales outbreak: Another dark side of COVID-19

“…Understaffing which can be assessed by the healthcare worker: patient ratio was previously associated with a higher risk of eXDR cross-transmission. 4 Despite sufficient staff, the burden of care for these patients in prone positions was high. Then, the implementation of COVID-19 IPC measures that are more restrictive than those for eXDR could have falsely reassured medical and paramedical staff.…”

“…Last, antimicrobial exposure was previously associated with hospital acquisition of CPE strains and with an outbreak of MRSA. 4 , 15 , 16 However, as the outbreak occurs in an additional COVID department which was opened for 20 days, we were not able to compare antibiotic consumption to baseline use. Finally, as eXDR cross-transmission occurred, we could hypothesize cross-transmission of other micro-organisms, such as MRSA, ESBL-producing Enterobacterales or Clostridium difficile occurred in this department.…”

“…However, these units also experienced overwork due to the rapid increase of patients' admissions and shortages in personal protective equipment (PPE) which could play a role in hospital-transmissions. 4,5 In this particular context, we describe an outbreak of an NDM-5-producing Escherichia coli occurring in an ICU dedicated to COVID-19-patients.…”

Increased Risk for Carbapenem-ResistantEnterobacteriaceaeColonization in Intensive Care Units after Hospitalization in Emergency Department

“…In this scenario, good hand hygiene may not be achievable. Dividing patients into cohorts and assigning dedicated staff may reduce transmission of CRE (29). Hospital staff should discuss screening strategies for CRE and early isolation and contact precautions in the ED (30).…”

Cohorting for preventing the nosocomial spread of carbapenemase-producing Enterobacterales in non-epidemic settings: should it be mandatory?

“…the number of days from the admission to the acquisition) and the number of patients colonized or infected by CPE in a care unit were also defined as risk factors for acquisition [60e64]. Another prospective cohort study that evaluated risk factors for acquisition at ward level concluded that high colonization pressure and antibiotic consumption, both potentialized by HCW:patient ratio, were associated with CPE transmission [63].…”