title: Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection.
abstract: BACKGROUND
  The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for hospitalized patients, and effective strategies are needed.
  
  
  OBJECTIVE
  To assess the effect of an intensified intervention, which included active surveillance, on the incidence of infection with carbapenem-resistant Klebsiella pneumoniae.
  
  
  METHODS
  Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.
  
  
  METHODS
  Quasi-experimental study.
  
  
  METHODS
  The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series analysis was performed.
  
  
  RESULTS
  The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K. pneumoniae infection.
  
  
  CONCLUSIONS
  The use of active surveillance and contact precautions, as part of a multifactorial intervention, may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K. pneumoniae colonization or infection.
authors.affiliation: Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel. Debby.BenDavid@sheba.health.gov.il
authors.forename: Debby
authors.initials: D
authors.lastname: Ben-David
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Maor
authors.forename: Nathan
authors.initials: N
authors.lastname: Keller
authors.forename: Gili
authors.initials: G
authors.lastname: Regev-Yochay
authors.forename: Ilana
authors.initials: I
authors.lastname: Tal
authors.forename: Dalit
authors.initials: D
authors.lastname: Shachar
authors.forename: Amir
authors.initials: A
authors.lastname: Zlotkin
authors.forename: Gill
authors.initials: G
authors.lastname: Smollan
authors.forename: Galia
authors.initials: G
authors.lastname: Rahav
mesh_terms: D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D003140:Communicable Disease Control / Q000379:methods / Q000458:organization & administration; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D016521:Electrophoresis, Gel, Pulsed-Field; D017052:Hospital Mortality; D006784:Hospitals, Teaching; D006801:Humans; D007557:Israel; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics; D011159:Population Surveillance / Q000379:methods*
chemical_list: D015780:Carbapenems