title: Epidemiological surveillance of multidrug-resistant gram-negative bacteria in a solid organ transplantation department.
abstract: BACKGROUND
  We assessed the impact of intensified infection control measures (ICM) on colonization and infection caused by carbapenem-resistant (CR) Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii in a solid organ transplantation (SOT) department.
  
  
  METHODS
  A quasi-experimental methodology was followed. The study was divided into three periods: pre-intervention, intervention with implementation of an ICM bundle including active surveillance program (ASP) and gradually enhanced measures, and post-ASP without ASP. The bundle included active surveillance cultures, contact precautions, hand hygiene, education of health care workers (HCWs), monitoring of compliance, and environmental cleaning. Incidence of colonization and infection caused by CR gram-negative bacteria was recorded. Molecular analysis of CR bacteria was performed for a certain period.
  
  
  RESULTS
  During the intervention, incidence of colonization reduced from 19% to 9% (P<.001). The compliance of HCWs with contact precautions and hand hygiene also improved. Monthly incidence of infections caused by these CR bacteria increased from 2.8 to 6.9/1000 bed-days (P<.001). However, this increase did not have such a strong trend after the intervention. Most K. pneumoniae isolates, the commonest pathogen, carried the blaKPCgene. Colonization and infection rates by CR K. pneumoniae, P. aeruginosa, and A. baumannii were high among SOT recipients.
  
  
  CONCLUSIONS
  In settings where CR gram-negative bacteria are endemic, colonization and infection rates by these bacteria are high among SOT recipients. Implementation of enhanced ICM in all related units of a hospital, although challenging, reduces colonization rates by CR gram-negative bacteria.
authors.affiliation: Solid Organ Transplantation Department, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Geladari
authors.affiliation: Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Karampatakis
authors.affiliation: Third Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.|Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Antachopoulos
authors.affiliation: Third Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.|Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Iosifidis
authors.affiliation: Third Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.|Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Olga
authors.initials: O
authors.lastname: Tsiatsiou
authors.affiliation: Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece.
authors.forename: Lida
authors.initials: L
authors.lastname: Politi
authors.affiliation: Microbiology Department, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Aggeliki
authors.initials: A
authors.lastname: Karyoti
authors.affiliation: Solid Organ Transplantation Department, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Papanikolaou
authors.affiliation: Microbiology Department, National and Kapodistrian University School of Medicine, Athens, Greece.
authors.forename: Athanassios
authors.initials: A
authors.lastname: Tsakris
authors.affiliation: Third Department of Pediatrics, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.|Infection Control Committee, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
mesh_terms: D040981:Acinetobacter baumannii / Q000302:isolation & purification / Q000502:physiology; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D062665:Epidemiological Monitoring; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000502:physiology; D065228:Non-Randomized Controlled Trials as Topic; D016377:Organ Transplantation / Q000009:adverse effects*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification / Q000502:physiology; D012189:Retrospective Studies
chemical_list: D015780:Carbapenems
keywords: 
  Acinetobacter baumannii
  ; Klebsiella pneumoniae; Pseudomonas aeruginosa; active surveillance; carbapenem-resistant gram-negative bacteria; infection control; solid organ transplantation