title: Proactive infection control measures to prevent nosocomial transmission of carbapenem-resistant Enterobacteriaceae in a non-endemic area.
abstract: BACKGROUND
  Identification of hospitalized carbapenem-resistant Enterobacteriaceae (CRE)-positive patient is important in preventing nosocomial transmission. The objective of this study was to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between October 1, 2010 and December 31, 2011.
  
  
  METHODS
  The program included active surveillance culture in patients with history of medical tourism with hospitalization and surgical operation outside Hong Kong within 12 months before admission, and "added test" as an opportunistic CRE screening in all fecal specimens submitted to the laboratory. Outbreak investigation and contact tracing were conducted for CRE-positive patients. Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.
  
  
  RESULTS
  During the study period, a total of 6533 patients were screened for CRE, of which 76 patients were positive (10 from active surveillance culture, 65 from "added test", and 1 secondary case from contact tracing of 223 patients with no nosocomial outbreak), resulting in an overall rate of CRE fecal carriage of 1.2%. The median time of fecal carriage of CRE was 43 days (range, 13-119 days). Beta-lactam-beta-lactamase-inhibitors, cephalosporins, and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection, while use of cephalosporins, carbapenems, and fluoroquinolones after CRE detection are significantly associated with longer duration of carriage. The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load (Pearson correlation: 0.53; P = 0.02).
  
  
  CONCLUSIONS
  Proactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.
authors.affiliation: Department of Microbiology, Queen Mary Hospital, Hong Kong, China; Infection Control Team, Queen Mary Hospital, Hong Kong, China.
authors.forename: Vincent Chi-Chung
authors.initials: VC
authors.lastname: Cheng
authors.forename: Jasper Fuk-Woo
authors.initials: JF
authors.lastname: Chan
authors.forename: Sally Cheuk-Ying
authors.initials: SC
authors.lastname: Wong
authors.forename: Jonathan Hon-Kwan
authors.initials: JH
authors.lastname: Chen
authors.forename: Josepha Wai-Ming
authors.initials: JW
authors.lastname: Tai
authors.forename: Mei-Kum
authors.initials: MK
authors.lastname: Yan
authors.forename: Grace See-Wai
authors.initials: GS
authors.lastname: Kwan
authors.forename: Herman
authors.initials: H
authors.lastname: Tse
authors.forename: Kelvin Kai-Wang
authors.initials: KK
authors.lastname: To
authors.forename: Pak-Leung
authors.initials: PL
authors.lastname: Ho
authors.forename: Kwok-Yung
authors.initials: KY
authors.lastname: Yuen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D015780:Carbapenems / Q000627:therapeutic use*; D002511:Cephalosporins / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects*; D004756:Enterobacteriaceae Infections / Q000517:prevention & control* / Q000635:transmission*; D024841:Fluoroquinolones / Q000627:therapeutic use; D006801:Humans; D017053:Infection Control / Q000379:methods*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D002511:Cephalosporins; D024841:Fluoroquinolones