title: Control strategies for carbapenemase-producing Enterobacteriaceae at different levels of the healthcare system.
abstract: There has been a rapid increase in recent years in the incidence of infection and colonization by carbapenemase-producing Enterobacteriaceae (CPE). A number of clusters and outbreaks have been reported, some of which have been contained, providing evidence that these clusters and outbreaks can be managed effectively when the appropriate control measures are implemented. This review outlines strategies recommended to control CPE dissemination both at the healthcare facility level (acute and long-term care) and from the public health point of view. A dedicated prepared plan should be required to prevent the spread of CPE at the hospital level. At the front line, activities should include management of patients at admission and new cases, active surveillance culturing and definition of high-risk groups. High compliance with standard precautions for all patients and full or modified contact precautions for defined categories of patients should be implemented. Long-term care facilities are areas where dissemination can also take place but more importantly they can become a reservoir as patients are admitted and released to other Health care facilities. From the public health point of view, surveillance must be tailored to identify regional spread and interfacility transmission to prevent further dissemination. Finally, a comprehensive set of activities at various levels is necessary to prevent further spread of these bacteria in the community.
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Asensio
authors.affiliation: Servicio de Medicina Preventiva, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain.
authors.forename: Mireia
authors.initials: M
authors.lastname: Cantero
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Shaw
authors.affiliation: Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Vergara-López
mesh_terms: D000900:Anti-Bacterial Agents / Q000378:metabolism / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D015780:Carbapenems / Q000378:metabolism; D057189:Checklist; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D003955:Diagnostic Tests, Routine; D004197:Disease Reservoirs; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D006268:Health Facilities; D006801:Humans; D017053:Infection Control / Q000379:methods / Q000458:organization & administration*; D009313:National Health Programs; D011159:Population Surveillance; D012112:Residential Facilities; D013030:Spain / Q000453:epidemiology; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemase-producing Enterobacteriaceae; Control de la infección; Enterobacterias productoras de carbapenemasas; Healthcare facilities; Hospital preparation plan; Infection control; Instituciones de crónicos; Instituciones sanitarias; Long-term care facilities; Plan de preparación para el hospital