Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection.
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.
Ben-David
Debby
D
Infectious Diseases Unit, Sheba Medical Center, Tel Hashomer, Israel. Debby.BenDavid@sheba.health.gov.il
Maor
Yasmin
Y
Keller
Nathan
N
Regev-Yochay
Gili
G
Tal
Ilana
I
Shachar
Dalit
D
Zlotkin
Amir
A
Smollan
Gill
G
Rahav
Galia
G
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*
D015780:Carbapenems