Successful Control of an Outbreak of<i>Klebsiella pneumoniae</i>Carbapenemase—Producing<i>K. pneumoniae</i>at a Long-Term Acute Care Hospital

Munoz-Price, L. Silvia; Hayden, Mary K.; Lolans, Karen; Won, Sarah; Calvert, Karen; Lin, Michael; Stemer, Alexander; Weinstein, Robert A.

doi:10.1086/651097

Cited by 161 publications

(117 citation statements)

References 28 publications

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“…Salvage rectal swab specimens were obtained over a 7-month period (June 2008 through January 2009) from 3 sources: (i) specimens collected routinely at the time of admission to a long-term acute-care hospital to screen for multidrug-resistant organisms; (ii) specimens collected during 4-point prevalence surveys conducted as a component of an outbreak control program at the same long-term acute-care hospital (12); and (iii) swabs collected as part of routine point prevalence surveys to screen for KPCs at two different nursing homes. The long-term acute-care hospital and one nursing home were part of a regional outbreak of KPC-producing bacteria in northwest Indiana and south suburban Chicago (12,28). The second nursing home was experiencing an unrelated outbreak of KPC-positive bacteria.…”

Section: Methodsmentioning

confidence: 99%

Direct Ertapenem Disk Screening Method for Identification of KPC-Producing Klebsiella pneumoniae and Escherichia coli in Surveillance Swab Specimens

Lolans

Calvert²,

Won

et al. 2010

J Clin Microbiol

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Klebsiella pneumoniae carbapenemase (KPC) production in Gram-negative bacilli is an increasing problem worldwide. Rectal swab surveillance is recommended as a component of infection prevention programs, yet few screening methods are published. We compared detection of KPC-producing Klebsiella pneumoniae and Escherichia coli in surveillance specimens by 2 methods: (i) inoculation of swabs in tryptic soy broth containing 2 g/ml imipenem followed by plating to MacConkey agar (MAC) (method 1) and (ii) streaking swabs on MAC onto which a 10-g ertapenem disk was then placed (method 2). Simulated rectal swab specimens of challenge isolates from a collection of well-characterized K. pneumoniae and E. coli strains and salvage rectal swab specimens collected from patients at 4 different health care facilities over a 7-month period were tested. The gold-standard comparator was bla KPC PCR testing of isolates. Method 1 detected 4/9 (44%) KPC-positive challenge isolates. By method 2, 9/9 KPC-positive challenge isolates exhibited zones of inhibition of <27 mm; all KPC-negative isolates exhibited zones of inhibition greater than 27 mm. The sensitivity and specificity of method 1 for detection of KPC-positive K. pneumoniae and E. coli in 149 rectal swab specimens were 65.6% (95% confidence interval [CI], 46.8% to 80.8%) and 49.6% (95% CI, 40.3% to 58.9%), respectively. With method 2, a zone diameter of <27 mm had a sensitivity of 97.0% (95% CI, 82.5% to 99.8%) and specificity of 90.5% (95% CI, 83.3% to 94.9%) for detection of KPC in rectal swab specimens. Direct ertapenem disk testing is simpler, more sensitive, and more specific than selective broth enrichment with imipenem for detection of KPCproducing K. pneumoniae and E. coli in surveillance specimens.

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Section: Methodsmentioning

confidence: 99%

Direct Ertapenem Disk Screening Method for Identification of KPC-Producing Klebsiella pneumoniae and Escherichia coli in Surveillance Swab Specimens

Lolans

Calvert²,

Won

et al. 2010

J Clin Microbiol

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“…A study done in a "long-term acute care hospital" had success in controlling an outbreak of K. pneumonia carbapenemase (KPC)-producing K. pneumonia by combining daily 2% CHG baths for patients with enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. 12 Numerous additional studies have also confirmed the effectiveness of chlorhexidine [13][14][15] and, its effectivity against biofilm formation was also proven. 16 However, other research projects have found that the effectiveness of chlorhexidine against K. pneumonia is greatly reduced.…”

mentioning

confidence: 86%

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

Roode¹,

Bütow²

2018

Clin Med Res

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Objectives:Chlorhexidine is seen as the golden standard of disinfectants. It is widely used to clean surgical sites; however, many studies indicate resistance of pathogens to chlorhexidine. One study indicated that pathogenic microorganisms were isolated from the soft palate cleft region in 57% of patients with facial clefts. The objectives of our study were to determine (1) if chlorhexidine application is effective in removing pathogens from the surgical site in these patients, and (2) if any pathogens are isolated, determine if they are resistant to other antimicrobials. Design:A descriptive observational study. Settings:A private practice that specializes in facial cleft surgery, with a country-wide patient base. All procedures were executed by one oral and maxillofacial surgeon.Participants: All patients (N=50) who presented for primary repair of the soft palate cleft were included in the study. Inclusion criteria: written consent from parent(s), and patient cleared as systemically healthy by a pediatric physician. Exclusion criteria: patient(s) with systemic infections (eg, flu) and/or any local infections (eg, tonsillitis). There were 25 males and 25 females with an average age of 7 months and 16 days included in the study.Methods: Swabs were taken from the surgical site of all 50 patients with cleft soft palate and were sent for culture, identification and antimicrobial sensitivity. The swabs were taken before disinfecting the site as well as after 2 minutes of disinfecting the surgical site with chlorhexidine. Results were compared against each other.Results: Positive cultures with 28 different pathogenic microorganisms that were identified in 47 patients before cleaning the surgical site with the chlorhexidine. The most dominant pathogens were K. pneumonia (n=22), H. influenza (n=18) and S. aureus (n=10). Of the pathogens found, 13 (46%) were still present on the swabs taken after disinfecting with chlorhexidine. K. pneumonia (n= 13), H. influenza (n=11) and S. aureus (n=9) were still the most prevalent pathogens. Conclusions:This study demonstrated that 61 of the total of 113 pathogens isolated (54%), survived after 2 minutes of disinfecting the surgical and surrounding area with chlorhexidine, thus intensifying the chances of post-operative infection.

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“…Sanitary measures such as contact isolation, cohorting of positive patients and epidemiologic surveillance with weekly rectal swabs performed to all high-risk patients of the same ward of the index case have proven to be effective in limiting CPKP transmission. 14,15 Few studies have evaluated risk factors for colonization or infection so far. In ICU-admitted patients, the importance of prior antibiotic exposure, prior hospitalization, severe illness and respiratory failure has been emphasized, 16,17 together with bacterial genotype and phenotype.…”

Section: Epidemiologymentioning

confidence: 99%

Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

2014

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Carbapenemase-producing Klebsiella pneumoniae (CPKP) is rapidly emerging as a leading nosocomial infection in many countries, especially in Italy where it is considered endemic. In this paper we briefly summarize the main characteristics of this outbreak, focusing on its recent spread to elderly frail patients admitted to internal medicine and geriatric wards. Severity of disease, clinical complexity and a large number of comorbidities seem to be major risk factors in clinical practice, although scientific evidence is still lacking, since until now studies have been carried out mainly in intensive care settings. We also discuss the possible role of gut microbiota in CPKP colonization onset and the possible role of pre-probiotics in promoting eradication.

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Successful Control of an Outbreak ofKlebsiella pneumoniaeCarbapenemase—ProducingK. pneumoniaeat a Long-Term Acute Care Hospital

Abstract: A bundled intervention was successful in preventing horizontal spread of KPC-producing gram-negative rods in a long-term acute care hospital, despite ongoing admission of patients colonized with KPC producers.

Cited by 161 publications

References 28 publications

Direct Ertapenem Disk Screening Method for Identification of KPC-Producing Klebsiella pneumoniae and Escherichia coli in Surveillance Swab Specimens

Direct Ertapenem Disk Screening Method for Identification of KPC-Producing Klebsiella pneumoniae and Escherichia coli in Surveillance Swab Specimens

A Descriptive Study of Chlorhexidine as a Disinfectant in Cleft Palate Surgery

Carbapenemase-producing Klebsiella pneumoniae in elderly frail patients admitted to medical wards

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