title: Impact of a hospital-wide multifaceted programme for reducing carbapenem-resistant Enterobacteriaceae infections in a large teaching hospital in northern Italy.
abstract: We performed a quasi-experimental study of a multifaceted infection control programme for reducing carbapenem-resistant Enterobacteriaceae (CRE) transmission and bloodstream infections (BSIs) in a 1420-bed university-affiliated teaching hospital during 2010-2014, with 30 months of follow-up. The programme consisted of the following: (a) rectal swab cultures were performed in all patients admitted to high-risk units (intensive-care units, transplantation, and haematology) to screen for CRE carriage, or for any room-mates of CRE-positive patients in other units; (b) cohorting of carriers, managed with strict contact precautions; (c) intensification of education, cleaning and hand-washing programmes; and (d) promotion of an antibiotic stewardship programme carbapenem-sparing regimen. The 30-month incidence rates of CRE-positive rectal cultures and BSIs were analysed with Poisson regression. Following the intervention, the incidence rate of CRE BSI (risk reduction 0.96, 95% CI 0.92-0.99, p 0.03) and CRE colonization (risk reduction 0.96, 95% CI 0.95-0.97, p <0.0001) significantly decreased over a period of 30 months. After accounting for changes in monthly census and percentage of externally acquired cases (positive at ≤72 h), the average institutional monthly rate of compliance with CRE screening procedures was the only independent variable associated with a declining monthly incidence of CRE colonization (p 0.002). The monthly incidence of CRE carriage was predictive of BSI (p 0.01). Targeted screening and cohorting of CRE carriers and infections, combined with cleaning, education, and antimicrobial stewardship measures, significantly decreased the institutional incidence of CRE BSI and colonization, despite endemically high CRE carriage rates in the region.
authors: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy. Electronic address: pierluigi.viale@unibo.it.
authors: P
authors: P
authors: Viale
authors: Infection Control Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: F
authors: F
authors: Tumietto
authors: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: M
authors: M
authors: Giannella
authors: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: M
authors: M
authors: Bartoletti
authors: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: S
authors: S
authors: Tedeschi
authors: Operative Unit of Microbiology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: S
authors: S
authors: Ambretti
authors: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: F
authors: F
authors: Cristini
authors: Hospital Directory, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: C
authors: C
authors: Gibertoni
authors: Hospital Directory, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: S
authors: S
authors: Venturi
authors: Hospital Directory, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: M
authors: M
authors: Cavalli
authors: Hospital Directory, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: A
authors: A
authors: De Palma
authors: Operative Unit of Pharmacy, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: M C
authors: MC
authors: Puggioli
authors: Infection Control Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: D
authors: D
authors: Mosci
authors: Infection Control Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: E
authors: E
authors: Callea
authors: Infection Control Unit, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: R
authors: R
authors: Masina
authors: Emilia-Romagna Regional Agency for Health and Social Care, Bologna, Italy.
authors: M L
authors: ML
authors: Moro
authors: Department of Medical and Surgical Sciences, Section of Infectious Diseases, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy.
authors: R E
authors: RE
authors: Lewis
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology* / Q000517:prevention & control*; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D011159:Population Surveillance; D012621:Seasons; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Active screening; Carbapenem-resistant Enterobacteriaceae; Infection control; antimicrobial stewardship; rectal swabs