title: Successful containment of carbapenem-resistant Enterobacteriaceae by strict contact precautions without active surveillance.
abstract: BACKGROUND
  Carbapenem-resistant Enterobacteriaceae (CRE) are a growing problem worldwide. Guidelines focus on carbapenemase-producing organisms, and little is known about whether strict adherence to infection control measures is effective for CRE without carbapenemase. During 2009, CRE increased markedly in a tertiary hospital, and enhanced infection control measures without active surveillance were adopted.
  
  
  METHODS
  Beginning in April 2010, enhanced antimicrobial stewardship, strict contact precautions, and cohort isolation were adopted. After September 2010, hand hygiene performance was prospectively monitored by active surveillance, and results were monthly fed back to medical personnel. Available carbapenem-resistant Escherichia coli (ECO) and carbapenem-resistant Klebsiella pneumoniae (KPN) isolated during 2008-2010 were characterized. Imipenem and meropenem minimal inhibitory concentrations were confirmed by E-test (AB biodisk, Solna, Sweden). Phenotypic screening assays and polymerase chain reaction (PCR) amplification of known β-lactamase and carbapenemase genes were performed.
  
  
  RESULTS
  From 3,511 ECO and 2,279 KPN, 44 (0.76%) were CRE (3 ECO, 41 KPN). CRE incidence rates rose from 1.61 in 2008 to 5.49 in 2009; they rose further to 9.81 per 100,000 patient days in early 2010. After adoption of strict infection control measures, CRE frequency fell back in 2011 and remained at baseline afterward. Phenotypic screening and PCR showed AmpC β-lactamase and extended spectrum β-lactamases with or without loss of porins; carbapenemases were not detected.
  
  
  CONCLUSIONS
  Enhanced infection control measures, even without active surveillance, seem effective to prevent further spread of CRE in a low-prevalence setting with mainly carbapenemase-nonproducing CRE.
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Nak-Hyun
authors.initials: NH
authors.lastname: Kim
authors.affiliation: Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Woong-Dae
authors.initials: WD
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.affiliation: Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Hye-Kyung
authors.initials: HK
authors.lastname: Seo
authors.affiliation: Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Myoung-jin
authors.initials: MJ
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Taek Soo
authors.initials: TS
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
authors.forename: Kyoung Un
authors.initials: KU
authors.lastname: Park
authors.affiliation: Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Division of Antimicrobial Resistance, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea.
authors.forename: Jung Sik
authors.initials: JS
authors.lastname: Yoo
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Infectious Diseases, Seoul National University Bundang Hospital, Seongnam, Republic of Korea; Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. Electronic address: hbkimmd@snu.ac.kr.
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D015780:Carbapenems / Q000494:pharmacology*; D003264:Containment of Biohazards / Q000379:methods*; D003428:Cross Infection / Q000517:prevention & control*; D004755:Enterobacteriaceae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D006784:Hospitals, Teaching; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007710:Klebsiella Infections / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D010641:Phenotype; D015995:Prevalence; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D013845:Thienamycins / Q000494:pharmacology; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D013845:Thienamycins; D015378:Imipenem; D001618:beta-Lactamases; C063912:carbapenemase; D000077731:Meropenem
keywords: Carbapenem resistance; Contact precaution; Enterobacteriaceae