title: Control of simultaneous outbreaks of carbapenemase-producing enterobacteriaceae and extensively drug-resistant Acinetobacter baumannii infection in an intensive care unit using interventions promoted in the Centers for Disease Control and Prevention 2012 carbapenemase-resistant Enterobacteriaceae Toolkit.
abstract: OBJECTIVE
  We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention's 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).
  
  
  METHODS
  Before-after intervention study.
  
  
  METHODS
  Fifteen-bed surgical trauma intensive care unit (ICU).
  
  
  METHODS
  We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.
  
  
  RESULTS
  The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified.
  
  
  CONCLUSIONS
  Use of infection control measures described in the Centers for Disease Control and Prevention's 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
authors.forename: Kyle B
authors.initials: KB
authors.lastname: Enfield
authors.forename: Nujhat N
authors.initials: NN
authors.lastname: Huq
authors.forename: Megan F
authors.initials: MF
authors.lastname: Gosseling
authors.forename: Darla J
authors.initials: DJ
authors.lastname: Low
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Hazen
authors.forename: Denise M
authors.initials: DM
authors.lastname: Toney
authors.forename: Gavin
authors.initials: G
authors.lastname: Slitt
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Zapata
authors.forename: Heather L
authors.initials: HL
authors.lastname: Cox
authors.forename: Jessica D
authors.initials: JD
authors.lastname: Lewis
authors.forename: John R
authors.initials: JR
authors.lastname: Kundzins
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Mathers
authors.forename: Costi D
authors.initials: CD
authors.lastname: Sifri
mesh_terms: D000046:Academic Medical Centers; D000151:Acinetobacter Infections / Q000517:prevention & control*; D040981:Acinetobacter baumannii / Q000187:drug effects* / Q000302:isolation & purification; D015780:Carbapenems / Q000494:pharmacology*; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D017063:Outcome Assessment, Health Care; D014481:United States; D014768:Virginia
chemical_list: D015780:Carbapenems