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Published on: August 30, 2018
Role of infection control measures in limiting morbidity associated with multi-resistant organisms in critically ill
B Souweine1, O Traore, B Aublet-Cuvelier
1Service de Réanimation Médicale Polyvalente, Clermont-Ferrand, France.
Abstract:
A retrospective comparative study was performed to determine the impact of infection control measures (ICMs) on colonization and infections due to methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae (producing transferable extended-spectrum beta-lactamase, KPESBL), and multi-resistant Enterobacter aerogenes (MREA) in intensive care unit patients. Infection Control Measures included surveillance cultures, isolation procedures and mupirocin for MRSA nasal carriage. The numbers of patients infected and/or colonized by MRSA, KPESBL or MREA were compared during two consecutive one-year periods (Period 1 before ICMs, and Period 2 after ICMs). The antibiotic consumption during the two periods was analysed. In Period 1 and Period 2, respectively, the rate of patients infected or colonized by at least one of the three organisms was 15% and 6.8% (P=0.001); by MRSA 7.7% and 2.6% (P=0. 004); by KPESBL 1.7% and 0% (P=0.25); and by MREA 5.6% and 4.3% (P=0. 47). During Period 2, there was a clear-cut decrease in the percentage of patients infected by MRSA (P=0.018), a non-significant decrease in those infected by KPESBL (P=0.06), and no decrease in patients infected by MREA (P=0.22). When calculated per 1000 patient-days, for Period 1 and Period 2, respectively, the rate of patients infected or colonized by at least one of the three organisms was 11.9 and 8.8; for MRSA it was 4 and 2.2; for KPESBL it was 1 and 0; and for MREA it was 4 and 4. Antibiotic cost was pound98.7 in Period 1 and pound62.7 in Period 2. ICMs contributed to the control of infections and colonizations due to MRSA and KPESBL but not those due to MREA.
Insights
Implementing infection control measures significantly reduced methicillin-resistant Staphylococcus aureus (MRSA) and Klebsiella pneumoniae (KPESBL) infections in ICUs. However, these measures did not impact multi-resistant Enterobacter aerogenes (MREA) infections.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Intensive care units (ICUs) are high-risk environments for multidrug-resistant organism (MDRO) colonization and infection.
- Methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae producing transferable extended-spectrum beta-lactamase (KPESBL), and multi-resistant Enterobacter aerogenes (MREA) are significant pathogens in ICUs.
Purpose of the Study:
- To evaluate the effectiveness of implemented infection control measures (ICMs) on MRSA, KPESBL, and MREA colonization and infection rates in ICU patients.
- To assess the impact of ICMs on antibiotic consumption and costs within the ICU setting.
Main Methods:
- A retrospective comparative study analyzing data from two consecutive one-year periods: before (Period 1) and after (Period 2) the implementation of ICMs.
- ICMs included surveillance cultures, isolation procedures, and mupirocin for MRSA nasal carriage.
- Patient colonization and infection rates, as well as antibiotic consumption, were compared between the two periods.
Main Results:
- Overall rates of patients infected or colonized by at least one of the three target organisms decreased significantly from 15% in Period 1 to 6.8% in Period 2 (P=0.001).
- MRSA rates showed a significant reduction in both colonization/infection (7.7% to 2.6%, P=0.004) and infection (P=0.018).
- KPESBL rates decreased non-significantly, while MREA rates showed no significant change in colonization/infection or infection rates between periods. Antibiotic costs decreased from £98.7 to £62.7.
Conclusions:
- Implemented infection control measures were effective in controlling MRSA and KPESBL colonization and infections in the ICU.
- ICMs did not demonstrate a significant impact on MREA colonization or infection rates.
- The study highlights the differential effectiveness of specific ICMs against various multidrug-resistant organisms and suggests a potential reduction in antibiotic use and associated costs.
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