Successful Containment of the First KPC-Producing Klebsiella Pneumoniae Outbreak in Croatia

Abstract

The rapid detection of KPC-producing K. pneumoniae and vigorous implementation of infection control measures were necessary to successfully control the outbreak.

Infection prevention and control strategies against carbapenem resistant Enterobacteriaceae – a systematic review

“…Considering IPC standard and transmission-based precautions (Table 3), hand hygiene was described in 19 (63%) of the 30 reviewed studies. Hand hygiene compliance was evaluated using the WHO protocol (Brkic et al, 2017), according to ‘The Five Moments for Hand Hygiene’ (Barratt et al, 2017; Li et al, 2019). In several reviewed studies, hand hygiene compliance was evaluated, using direct observation methodology, included in training sessions and promoted not only to HCW (Ece et al, 2018) but also to other stakeholders, such as the relatives who visit patients (Hernández-García et al, 2019; Protonotariou et al, 2018).…”

“…Several reviewed studies suggest transversal standard and transmission-based IPC (Battikh et al, 2017; Brkic et al, 2017; Gu et al, 2018; Spencer et al, 2019; Yan et al, 2019) crucial to contain CRE and other pathogens dissemination (Protonotariou et al, 2018), at all moments, not only in outbreaks (Castagnola et al, 2019), and in all settings, including homecare (Ahn et al, 2019). IPC practices should be tailored to the level of care that is being provided in the different healthcare settings and combined with the inherent risk to individuals and population (PHAC, 2012).…”

“…The reviewed studies had some limitations that can provide clues for future research (Shamseer et al, 2015). Small sample sizes (Battikh et al, 2017; Brkic et al, 2017; Borgmann et al, 2018; Chen et al, 2019; Gorgulho et al, 2020; Gu et al, 2018; Li et al, 2019), single-centre studies (Chen et al, 2019; Kong et al, 2019; Li et al, 2019; Madueno et al, 2017), small number of environmental samples (Decraene et al, 2018; Yan et al, 2019) and information on antimicrobial consumption limited to facilities records (Cienfuegos-Gallet et al, 2019) were indicated as limitations. Unknown CREC and CRKP transmission routes (Borgmann et al, 2018; Li et al, 2019) were also highlighted as relevant limitations as well as the retrospective (Chen et al, 2019; Madueno et al, 2017; Spencer et al, 2019) and observational (Decraene et al, 2018; Gorgulho et al, 2020) nature of data collection.…”

“…Absence of ASC limited the studies by reducing the availability of important information on CRE incidence and prevalence (Cienfuegos-Gallet et al, 2019; Protonotariou et al, 2018). For future studies, authors suggested the implementation of multicentric studies (Borgmann et al, 2018; Chen et al, 2019; Li et al, 2019; Madueno et al, 2017) with significant sample sizes (Battikh et al, 2017; Borgmann et al, 2018; Brkic et al, 2017; Chen et al, 2019; Gu et al, 2018; Li et al, 2019). Although retrospective data is significant to understand the background of the studied population and facilities, it is important to monitor patients progress during their stay in the healthcare facility, and thus prospective studies are important to be conducted.…”