Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions
Outbreak of Carbapenem-Resistant Enterobacteriaceae at a Long-Term Acute Care Hospital: Sustained Reductions in Transmission through Active Surveillance and Targeted Interventions
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DOI：
10.1086/667738
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发表时间：
2012-10-01
影响因子：
4.5
通讯作者：
Wise, Matthew E.
中科院分区：
文献类型：
--
作者：
Chitnis, Amit S.;Caruthers, Pam S.;Wise, Matthew E.
目标。描述一次产碳青霉烯酶（KPC）的肺炎克雷伯菌耐碳青霉烯肠杆菌科（CRE）暴发和预防传播的干预措施。设计，环境和病人。某长期急症医院（LTACH）患者CRE暴发流行病学调查。审查了2009年3月至2011年2月LTACH A的微生物学记录，以确定CRE传播病例和因CRE入院的病例。2009年3月至2011年7月期间发现了CRE菌血症发作。2010年7月至2011年7月期间，每两周进行一次CRE患病率调查，并实施了预防传播的干预措施，包括对工作人员进行教育和审计，将CRE患者与专门的护理人员和共用医疗设备隔离和组合在一起。趋势评估使用加权线性或泊松回归。CRE传播病例被纳入病例对照研究，以评估感染的危险因素。采用实时聚合酶链反应法检测bla（KPC）基因，并采用脉冲场凝胶电泳技术评估分离物的遗传亲缘性。发现99例CRE传播病例，16例住院病例（来自7家急症医院），29例CRE菌血症发作。CRE患病率（49% vs 8%）、新发现CRE的筛查患者百分比（44% vs 0%）和CRE菌血症发生率（2.5 vs 0.0 / 1000患者日）均显著降低。病例更有可能接受了β -内酰胺类药物，患有糖尿病，需要机械通气。所有分离株均为产kpc的肺炎克雷伯菌，且几乎所有分离株均具有遗传亲缘关系。通过监测检测和有针对性的干预措施，可以减少CRE在LTACHs中的传播。卫生保健机构内部和机构之间的可持续减少可能需要采取区域公共卫生办法。感染控制医院流行病学2012；33 (10): 984 - 992
OBJECTIVE. To describe a Klebsiella pneumoniae carbapenemase (KPC)-producing carbapenem-resistant Enterobacteriaceae (CRE) outbreak and interventions to prevent transmission.DESIGN, SETTING, AND PATIENTS. Epidemiologic investigation of a CRE outbreak among patients at a long-term acute care hospital (LTACH).METHODS. Microbiology records at LTACH A from March 2009 through February 2011 were reviewed to identify CRE transmission cases and cases admitted with CRE. CRE bacteremia episodes were identified during March 2009-July 2011. Biweekly CRE prevalence surveys were conducted during July 2010-July 2011, and interventions to prevent transmission were implemented, including education and auditing of staff and isolation and cohorting of CRE patients with dedicated nursing staff and shared medical equipment. Trends were evaluated using weighted linear or Poisson regression. CRE transmission cases were included in a case-control study to evaluate risk factors for acquisition. A real-time polymerase chain reaction assay was used to detect the bla(KPC) gene, and pulsed-field gel electrophoresis was performed to assess the genetic relatedness of isolates.RESULTS. Ninety-nine CRE transmission cases, 16 admission cases (from 7 acute care hospitals), and 29 CRE bacteremia episodes were identified. Significant reductions were observed in CRE prevalence (49% vs 8%), percentage of patients screened with newly detected CRE (44% vs 0%), and CRE bacteremia episodes (2.5 vs 0.0 per 1,000 patient-days). Cases were more likely to have received beta-lactams, have diabetes, and require mechanical ventilation. All tested isolates were KPC-producing K. pneumoniae, and nearly all isolates were genetically related.CONCLUSION. CRE transmission can be reduced in LTACHs through surveillance testing and targeted interventions. Sustainable reductions within and across healthcare facilities may require a regional public health approach. Infect Control Hosp Epidemiol 2012;33(10):984-992