Successful Control of an Outbreak of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae at a Long-Term Acute Care Hospital
Successful Control of an Outbreak of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae at a Long-Term Acute Care Hospital
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DOI：
10.1086/651097
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发表时间：
2010-04-01
影响因子：
4.5
通讯作者：
Weinstein, Robert A.
中科院分区：
文献类型：
--
作者：
Munoz-Price, L. Silvia;Hayden, Mary K.;Weinstein, Robert A.
目标。确定一系列感染控制干预措施对爆发期间产生碳青霉烯酶（KPC）的肺炎克雷伯菌水平传播的影响。准实验study.SETTING。长期急诊医院干预2008年7月23日，实施了一项捆绑干预措施：每天为患者提供2%的葡萄糖酸氯己定沐浴，加强环境清洁，入院时进行监测培养，连续点流行监测（PPS），隔离预防措施和人员培训。在实施干预之前进行基线PPS。任何怀疑产生KPC的革兰氏阴性棒分离物都要进行改良的霍奇试验，如果结果为阳性，则进行确认性聚合酶链反应试验。临床病例被定义为在临床培养中产生kpc阳性革兰氏阴性棒的患者。2008年6月17日进行的基线PPS显示，产生kpc的分离株的定植率为21%（筛查的39例患者中有8例）。实施干预后，每月进行5次PPS检查，结果显示产kpc的分离株定殖率分别为12%、5%、3%、0%和0% （P < 0.001）。从2008年1月1日到采取干预措施，共发现8例kpc阳性临床病例，怀疑是由于水平传播。从实施干预措施到2008年12月31日，仅在2008年8月发现了2例kpc阳性临床病例。2008年1月1日至12月31日，8例患者入院时检测出产kpc分离株携带者，干预前4例，干预后4例。在一家长期急症护理医院，捆绑干预成功地防止了产生KPC的革兰氏阴性杆状体的水平传播，尽管不断有KPC生产者聚集的患者入院。
OBJECTIVE. To determine the effect of a bundle of infection control interventions on the horizontal transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae during an outbreak.DESIGN. Quasi-experimental study.SETTING. Long-term acute care hospital.INTERVENTION. On July 23, 2008, a bundled intervention was implemented: daily 2% chlorhexidine gluconate baths for patients, enhanced environmental cleaning, surveillance cultures at admission, serial point prevalence surveillance (PPS), isolation precautions, and training of personnel. Baseline PPS was performed before the intervention was implemented. Any gram-negative rod isolate suspected of KPC production underwent a modified Hodge test and, if results were positive, confirmatory polymerase chain reaction testing. Clinical cases were defined to occur for patients whose samples yielded KPC-positive gram-negative rods in clinical cultures.RESULTS. Baseline PPS performed on June 17, 2008, showed a prevalence of colonization with KPC-producing isolates of 21% (8 of 39 patients screened). After implementation of the intervention, monthly PPS was performed 5 times, which showed prevalences of colonization with KPC-producing isolates of 12%, 5%, 3%, 0%, and 0% (P < .001). From January 1, 2008, until the intervention, 8 KPC-positive clinical cases-suspected to be due to horizontal transmission-were detected. From implementation of the intervention through December 31, 2008, only 2 KPC-positive clinical cases, both in August 2008, were detected. From January 1 through December 31, 2008, 8 patients were detected as carriers of KPC-producing isolates at admission to the institution, 4 patients before and 4 patients after the intervention.CONCLUSION. 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.