title: Are strict isolation policies based on susceptibility testing actually effective in the prevention of the nosocomial spread of multi-drug-resistant gram-negative rods?
abstract: BACKGROUND
  The emergence of multi-drug-resistant gram-negative rods (MDR-GNRs) has become a worldwide problem. To limit the emergence of MDR-GNRs, a tertiary care cancer center in Japan implemented a policy that requires the pre-emptive isolation of patients with organisms that have the potential to be MDR-GNRs.
  
  
  METHODS
  A retrospective analysis was performed. Any gram-negative bacillus isolates categorized as intermediate or resistant to at least 2 classes of antimicrobials were subjected to contact precautions. The incidence of patients with MDR-GNRs was analyzed.
  
  
  RESULTS
  There was no difference between the preintervention and intervention time periods in the detection rate of nonfermenting MDR-GNR species (0.15 per 10,000 vs 0.35 per 10,000 patient-days, P = .08). There was an increase in the detection rate of multi-drug-resistant Enterobacteriaceae (0.19 per 10,000 vs 0.56 per 10,000 patient-days, P = .007), which was prominent for extended-spectrum β-lactamase (ESBL)-producing organisms (0.19 per 10,000 vs 0.50 per 10,000 patient-days, P = .02).
  
  
  CONCLUSIONS
  Our intervention kept the emergence of multi-drug-resistant non-glucose-fermenting gram-negative bacilli to a small number, but it failed to prevent an increase in ESBL producers. Policies, such as active detection and isolation, are warranted to decrease the incidence of these bacilli.
authors: Disease Control and Prevention Center, National Center for Global Health and Medicine, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan.
authors: Norio
authors: N
authors: Ohmagari
authors: Division of Infectious Diseases, Shizuoka Cancer Center, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan.
authors: Hanako
authors: H
authors: Kurai
authors: Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan.
authors: Yuka
authors: Y
authors: Yamagishi
authors: Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan. Electronic address: mikamo@aichi-med-u.ac.jp.
authors: Hiroshige
authors: H
authors: Mikamo
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D016946:Gram-Negative Aerobic Rods and Cocci / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006291:Health Policy; D006801:Humans; D015994:Incidence; D007564:Japan; D016134:Organizational Policy; D010356:Patient Isolation / Q000379:methods*; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: Isolation; Multi–drug-resistant gram negative bacilli; Precaution