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Is cohorting the only solution to control carbapenemase-producing Enterobacteriaceae outbreaks? A single-centre
C Legeay1, V Thépot-Seegers2, H Pailhoriès3
1Infection Control and Prevention Unit, CHU d'Angers, University of Angers, Angers, France.
The Journal of Hospital Infection
|February 14, 2018
Summary
High colonization pressure and antibiotic use drive the hospital spread of carbapenemase-producing Enterobacteriaceae (CPE). Understaffing, indicated by caregiver:patient ratio, exacerbates CPE transmission risks.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat.
- Hospital-acquired CPE transmission is a major concern, with cohorting being a costly and challenging control measure.
Purpose of the Study:
- To identify key ward-specific variables associated with in-hospital transmission of CPE.
- To investigate transmission dynamics in a setting where cohorting has not been implemented.
Main Methods:
- A prospective cohort study design was employed, comparing 14-day periods with and without CPE acquisition.
- Data collected included colonization pressure, caregiver:patient ratios, hand hygiene compliance, antibiotic consumption, and infection control team (ICT) involvement.
- Multivariate analysis was used to identify significant risk factors for CPE transmission.
Main Results:
- Colonization pressure (OR 1.12) and antibiotic consumption (OR 2.41) were significantly associated with increased CPE in-hospital transmission.
- A higher caregiver:patient ratio was found to potentiate the effects of both colonization pressure and antibiotic consumption.
- 18 out of 68 study periods (26.5%) documented at least one new CPE case acquisition.
Conclusions:
- Colonization pressure and antibiotic consumption are identified as primary drivers of CPE spread within hospitals.
- Understaffing, reflected by caregiver:patient ratios, plays a crucial role in facilitating CPE transmission.
- Strategies such as dedicated healthcare workers for CPE patients and enhanced coordination between infection control and antimicrobial stewardship teams are recommended to mitigate spread.
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