Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012

Abstract

In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate, and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140 CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10% (13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32) to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and strength of the measures implemented around the CPE index case: quick (within two days of patient admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an emerging stage.

Management of carbapenem resistant Klebsiella pneumoniae infections in stem cell transplant recipients: an Italian multidisciplinary consensus statement

“…Corrado Girmenia, 1 Claudio Viscoli, 2 Alfonso Piciocchi, 3 Laura Cudillo, 4 Stefano Botti, 5 Antonio Errico, 6 Loredana Sarmati, 7 Fabio Ciceri, 8 Franco Locatelli, 9 Maddalena Giannella, 10 Matteo Bassetti, 11 Carlo Tascini, 12 Letizia Lombardini, 6,13 Ignazio Majolino, 14 Claudio Farina, 15 Francesco Luzzaro, 16 Gian Maria Rossolini, [17][18][19] and …”

Carbapenemase-producing Enterobacteriaceae in Sweden 2007–2013: Experiences from seven years of systematic surveillance and mandatory reporting

“…However, CPE is not always included as mandatory reporting, such as in Spain, where the laboratories and health professionals are encouraged to submit strains for characterisation (Oteo et al, 2013). A French study on a long-term programme structured to control CPE emphasises the need for sustained and coordinated strategies for successful reduction of spread of these strains (Fournier et al, 2014). CPE strains are generally found in the hospital setting and rarely in the community.…”

First case of multidrug-resistant blaNDM-1- and blaOXA-232-carrying Klebsiella pneumoniae and its probable cross-transmission in a French hospital

“…Once a carbapenemase is identified, adequate infection control measures, including cohorting case and contact patients separately, should be rapidly implemented to prevent cross-transmission, as recommended by the French health authorities [5]. Implementation of a surveillance programme for controlling the spread of multidrug-resistant bacteria in French hospitals for the past 9 years showed that the number of secondary cases varied significantly depending on the speed and strictness with which the measures were implemented around the index case, including assignment of dedicated nursing staff and setup of simple barrier precautions [4].…”

“…On 11 March 2014, barrier precautions were implemented and measures for hand hygiene with alcohol-based products and room cleaning were reinforced. Moreover, the patient was managed by dedicated nursing staff, as recommended by the Assistance Publique-Hôpitaux de Paris (Paris, France) central infection control team [4]. In addition, screening for faecal carriage of NDM-1-and/or OXA-48-producing K. pneumoniae was performed in all contact patients.…”