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Published on: February 9, 2011
Epidemiological surveillance of multidrug-resistant gram-negative bacteria in a solid organ transplantation
Anastasia Geladari1, Theodoros Karampatakis2, Charalampos Antachopoulos3,4
1Solid Organ Transplantation Department, Medical Faculty, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
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 blaKPC gene. Colonization and infection rates by CR K. pneumoniae, P. aeruginosa, and A. baumannii were high among SOT recipients.
Conclusion:
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.
Insights
Intensified infection control measures (ICM) significantly reduced carbapenem-resistant (CR) bacteria colonization in solid organ transplant patients. However, CR infections initially increased but showed a less pronounced trend post-intervention, highlighting the challenge of endemic CR gram-negative bacteria.
Area of Science:
- Infectious Diseases
- Public Health
- Microbiology
Background:
- Carbapenem-resistant (CR) gram-negative bacteria pose a significant threat in healthcare settings, particularly for vulnerable solid organ transplantation (SOT) recipients.
- Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii are key pathogens associated with high morbidity and mortality in SOT patients due to antimicrobial resistance.
Purpose of the Study:
- To evaluate the effectiveness of intensified infection control measures (ICM) in reducing colonization and infection by CR gram-negative bacteria in an SOT department.
- To assess the impact of an active surveillance program (ASP) integrated within the ICM bundle.
Main Methods:
- A quasi-experimental study design was employed, comparing pre-intervention, intervention (ICM bundle with ASP), and post-intervention (ICM without ASP) periods.
- The ICM bundle included active surveillance cultures, contact precautions, hand hygiene, healthcare worker education, compliance monitoring, and environmental cleaning.
- Incidence of colonization and infection by CR gram-negative bacteria was systematically recorded, with molecular analysis performed for specific periods.
Main Results:
- Intensified ICM led to a significant reduction in CR bacteria colonization rates from 19% to 9% (P<.001).
- Healthcare worker compliance with contact precautions and hand hygiene improved during the intervention.
- A notable increase in monthly CR bacterial infections was observed during the intervention (2.8 to 6.9/1000 bed-days, P<.001), though this trend moderated post-intervention.
- Klebsiella pneumoniae, often carrying the blaKPC gene, was the most common pathogen, with high colonization and infection rates observed in SOT recipients.
Conclusions:
- CR gram-negative bacteria colonization and infection are highly prevalent among SOT recipients in endemic settings.
- Enhanced ICM, despite implementation challenges, is effective in reducing CR gram-negative bacteria colonization rates.
- Sustained efforts in infection control are crucial for managing CR bacteria in high-risk patient populations.
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