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Updated: Feb 25, 2026
Isolation and Identification of Waterborne Antibiotic-Resistant Bacteria and Molecular Characterization of their Antibiotic Resistance Genes
Published on: March 3, 2023
The association between infection control interventions and carbapenem-resistant Enterobacteriaceae incidence in an
K Hussein1, G Rabino2, O Eluk2
1Infectious Diseases Institute, Rambam Health Care Campus, Haifa, Israel; Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Background:
Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceae (CRE) starting in 2006.
Aim:
To assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and CRE incidence.
Methods:
Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospital-days, was plotted quarterly between 2005 and 2016. IC interventions were applied at different time-points throughout this period. Data were collected on IC staffing, number of rectal surveillance cultures, and carbapenem consumption. Autocorrelated segmented linear regression analysis was used to assess the time-points at which a significant change in the CRE incidence trend occurred, and the association between the timing of IC intervention implementation and observed CRE trends was assessed. Trends between time-points were expressed as quarterly percent change (QPC) with 95% confidence intervals (CIs).
Findings:
Between 2005 and 2008, CRE incidence increased significantly (QPC: 19.7%; CI: 11.5-28.4), reaching a peak of 186.6 new acquisitions per 100,000 hospital-days. From mid-2011 until the end of follow-up, there was a significantly decreasing incidence trend (QPC: -4.5; CI: -6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments, and carbapenem restriction were required. Decreasing CRE incidence was observed with an infectious diseases/IC staffing of 1.2-1.5 per 100 beds and 20,000-36,000 yearly CRE surveillance samples.
Conclusion:
A multi-faceted hospital-wide intervention programme is required to control CRE in hospital settings.
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