Containment of a Country-wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Israeli Hospitals via a Nationally Implemented Intervention
Containment of a Country-wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Israeli Hospitals via a Nationally Implemented Intervention
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DOI：
10.1093/cid/cir025
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发表时间：
2011-04-01
影响因子：
11.8
通讯作者：
Carmeli, Yehuda
中科院分区：
文献类型：
--
作者：
Schwaber, Mitchell J.;Lev, Boaz;Carmeli, Yehuda
背景。2006年期间，以色列医院面临耐碳青霉烯肺炎克雷伯菌克隆爆发，当地措施无法控制。开展了一项全国性的干预措施，以控制疫情的爆发，并引入一项战略，以控制今后耐抗生素细菌在医院的传播。2007年3月，卫生部发布了指导方针，要求对住院的碳青霉烯类耐药肠杆菌科（CRE）携带者进行物理隔离，并指定了专门人员，并任命了一个负责控制的专业工作组。工作队对急症护理医院进行了实地考察，评估了感染控制政策和实验室方法，通过对带菌者及其隔离条件的每日普查报告监督了对准则的遵守情况，每天向医院院长提供绩效反馈，并在必要时进行额外干预。最初的干预期为2007年4月1日至2008年5月31日。主要观察指标为临床诊断的院内CRE病例的发生率。截至2007年3月31日，27家医院的1275名患者受到感染（每100万人175例）。在干预之前，医院CRE的月发病率为每10万患者日55.5例。通过干预，CRE获得率的持续增长停止了，到2008年5月，每月新病例数减少到每10万患者日11.7例(P
Background. During 2006, Israeli hospitals faced a clonal outbreak of carbapenem-resistant Klebsiella pneumoniae that was not controlled by local measures. A nationwide intervention was launched to contain the outbreak and to introduce a strategy to control future dissemination of antibiotic-resistant bacteria in hospitals.Methods. In March 2007, the Ministry of Health issued guidelines mandating physical separation of hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) and dedicated staffing and appointed a professional task force charged with containment. The task force paid site visits at acute-care hospitals, evaluated infection-control policies and laboratory methods, supervised adherence to the guidelines via daily census reports on carriers and their conditions of isolation, provided daily feedback on performance to hospital directors, and intervened additionally when necessary. The initial intervention period was 1 April 2007-31 May 2008. The primary outcome measure was incidence of clinically diagnosed nosocomial CRE cases.Results. By 31 March 2007, 1275 patients were affected in 27 hospitals (175 cases per 1 million population). Prior to the intervention, the monthly incidence of nosocomial CRE was 55.5 cases per 100,000 patient-days. With the intervention, the continuous increase in the incidence of CRE acquisition was halted, and by May 2008, the number of new monthly cases was reduced to 11.7 cases per 100,000 patient-days (P