1887
  1. Home
  2. Eurosurveillance
  3. Volume 23, Issue 8, 22/Feb/2018
  4. Article
Research article Open Access
Like 0
Download

Abstract

An infection control programme was implemented in a 21,000-bed multihospital institution for controlling the spread of carbapenemase-producing Enterobacteriaceae (CPE) and glycopeptide-resistant (GRE), classified as ‘emergent extensively drug-resistant bacteria’ (eXDR) in France. We evaluated factors associated with outbreaks occurrence (n = 103), which followed 901 eXDR introductions (index case followed or not by secondary cases) from 2010 to 2015. In univariate analysis, knowing that patients had been hospitalised abroad, bacterial species (GRE vs CPE, as well as the CPE compared with the other Enterobacteriaceae species) and type of measures implemented within the first 2 days of hospitalisation were associated with outbreaks occurrence, but not the type of wards where carriers were hospitalised, nor the eXDR colonisation or infection status. In multivariate analysis, occurrence of outbreaks was significantly lower when contact precautions (odds ratio (OR): 0.34; 95% confidence interval (CI): 0.22–0.54) and even more when dedicated nursing staff (OR: 0.09; 95% CI: 0.02–0.39) were implemented around eXDR index cases within the first 2 days of hospitalisation (p < 10 − 3). GRE introductions were more frequently associated with occurrence of outbreaks than CPE (OR: 3.58; 95% CI: 2.32–5.51, p < 10 − 3). A sustained and coordinated strategy is efficient to limit the spread of eXDR at the scale of a large health institution.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2018.23.8.17-00078
2018-02-22
2024-12-26
/content/10.2807/1560-7917.ES.2018.23.8.17-00078
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/23/8/eurosurv-23-8-3.html?itemId=/content/10.2807/1560-7917.ES.2018.23.8.17-00078&mimeType=html&fmt=ahah

References

  1. Carmeli Y, Akova M, Cornaglia G, Daikos GL, Garau J, Harbarth S, et al. Controlling the spread of carbapenemase-producing Gram-negatives: therapeutic approach and infection control. Clin Microbiol Infect. 2010;16(2):102-11.  https://doi.org/10.1111/j.1469-0691.2009.03115.x  PMID: 20085604 
  2. Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20(9):821-30.  https://doi.org/10.1111/1469-0691.12719  PMID: 24930781 
  3. Cattoir V, Leclercq R. Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce? J Antimicrob Chemother. 2013;68(4):731-42.  https://doi.org/10.1093/jac/dks469  PMID: 23208830 
  4. Tenover FC, Weigel LM, Appelbaum PC, McDougal LK, Chaitram J, McAllister S, et al. Vancomycin-resistant Staphylococcus aureus isolate from a patient in Pennsylvania. Antimicrob Agents Chemother. 2004;48(1):275-80.  https://doi.org/10.1128/AAC.48.1.275-280.2004  PMID: 14693550 
  5. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2014. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2014.
  6. Donskey CJ. The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis. 2004;39(2):219-26.  https://doi.org/10.1086/422002  PMID: 15307031 
  7. Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012;18(3):268-81.  https://doi.org/10.1111/j.1469-0691.2011.03570.x  PMID: 21793988 
  8. Lepelletier D, Berthelot P, Lucet J-C, Fournier S, Jarlier V, Grandbastien BNational Working Group. French recommendations for the prevention of ‘emerging extensively drug-resistant bacteria’ (eXDR) cross-transmission. J Hosp Infect. 2015;90(3):186-95.  https://doi.org/10.1016/j.jhin.2015.04.002  PMID: 25986165 
  9. Fournier S, Brossier F, Fortineau N, Gillaizeau F, Akpabie A, Aubry A, et al. Long-term control of vancomycin-resistant Enterococcus faecium at the scale of a large multihospital institution: a seven-year experience. Euro Surveill. 2012;17(30): 20229. PMID: 22856512 
  10. Fournier S, Brun-Buisson C, Jarlier V. Twenty years of antimicrobial resistance control programme in a regional multi hospital institution, with focus on emerging bacteria (VRE and CPE). Antimicrob Resist Infect Control. 2012;1(1):9.  https://doi.org/10.1186/2047-2994-1-9  PMID: 22958336 
  11. Fournier S, Monteil C, Lepainteur M, Richard C, Brun-Buisson C, Jarlier V, et al. Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012. Euro Surveill. 2014;19(19):20802.  https://doi.org/10.2807/1560-7917.ES2014.19.19.20802  PMID: 24852956 
  12. Jarlier V, Trystram D, Brun-Buisson C, Fournier S, Carbonne A, Marty L, et al. Collégiale de Bactériologie-Virologie-Hygiène des Hôpitaux Universitaires de l’Ile de France. Curbing methicillin-resistant Staphylococcus aureus in 38 French hospitals through a 15-year institutional control program. Arch Intern Med. 2010;170(6):552-9.  https://doi.org/10.1001/archinternmed.2010.32  PMID: 20308642 
  13. Lepainteur M, Nérome S, Bendjelloul G, Monteil C, Cottard-Boulle B, Nion-Huang M, et al. Network of Infection Control Teams of Assistance Publique – Hôpitaux de Paris. Evaluation of excreta management in a large French multi-hospital institution. J Hosp Infect. 2015;91(4):346-50.  https://doi.org/10.1016/j.jhin.2015.07.009  PMID: 26386730 
  14. Société Française de Microbiologie (SFM). Comité de l’Antibiogramme de la Société Française de Microbiologie. Paris: SFM. French. Available from: http://www.sfm-microbiologie.org/page/page/showpage/page_id/90.html
  15. Grundmann H, Livermore DM, Giske CG, Canton R, Rossolini GM, Campos J, et al. CNSE Working Group. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill. 2010;15(46):19711.  https://doi.org/10.2807/ese.15.46.19711-en  PMID: 21144429 
  16. Schwaber MJ, Lev B, Israeli A, Solter E, Smollan G, Rubinovitch B, et al. Israel Carbapenem-Resistant Enterobacteriaceae Working Group. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis. 2011;52(7):848-55.  https://doi.org/10.1093/cid/cir025  PMID: 21317398 
  17. Schwaber MJ, Carmeli Y. An ongoing national intervention to contain the spread of carbapenem-resistant enterobacteriaceae. Clin Infect Dis. 2014;58(5):697-703.  https://doi.org/10.1093/cid/cit795  PMID: 24304707 
  18. Albiger B, Glasner C, Struelens MJ, Grundmann H, Monnet DLEuropean Survey of Carbapenemase-Producing Enterobacteriaceae. (EuSCAPE) working group. Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015. Euro Surveill. 2015;20(45):30062.  https://doi.org/10.2807/1560-7917.ES.2015.20.45.30062  PMID: 21317398 
  19. Ruppé E, Lixandru B, Cojocaru R, Büke C, Paramythiotou E, Angebault C, et al. Relative fecal abundance of extended-spectrum-β-lactamase-producing Escherichia coli strains and their occurrence in urinary tract infections in women. Antimicrob Agents Chemother. 2013;57(9):4512-7.  https://doi.org/10.1128/AAC.00238-13  PMID: 23836184 
  20. Cohen MJ, Block C, Levin PD, Schwartz C, Gross I, Weiss Y, et al. Institutional control measures to curtail the epidemic spread of carbapenem-resistant Klebsiella pneumoniae: a 4-year perspective. Infect Control Hosp Epidemiol. 2011;32(7):673-8.  https://doi.org/10.1086/660358  PMID: 21666398 
  21. Ben-David D, Maor Y, Keller N, Regev-Yochay G, Tal I, Shachar D, et al. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol. 2010;31(6):620-6.  https://doi.org/10.1086/652528  PMID: 20370465 
  22. Borer A, Eskira S, Nativ R, Saidel-Odes L, Riesenberg K, Livshiz-Riven I, et al. A multifaceted intervention strategy for eradication of a hospital-wide outbreak caused by carbapenem-resistant Klebsiella pneumoniae in Southern Israel. Infect Control Hosp Epidemiol. 2011;32(12):1158-65.  https://doi.org/10.1086/662620  PMID: 22080653 
  23. Agodi A, Voulgari E, Barchitta M, Politi L, Koumaki V, Spanakis N, et al. Containment of an outbreak of KPC-3-producing Klebsiella pneumoniae in Italy. J Clin Microbiol. 2011;49(11):3986-9.  https://doi.org/10.1128/JCM.01242-11  PMID: 21900525 
  24. Kochar S, Sheard T, Sharma R, Hui A, Tolentino E, Allen G, et al. Success of an infection control program to reduce the spread of carbapenem-resistant Klebsiella pneumoniae. Infect Control Hosp Epidemiol. 2009;30(5):447-52.  https://doi.org/10.1086/596734  PMID: 19301985 
  25. Haverkate MR, Bootsma MCJ, Weiner S, Blom D, Lin MY, Lolans K, et al. Modeling spread of KPC-producing bacteria in long-term acute care hospitals in the Chicago region, USA. Infect Control Hosp Epidemiol. 2015;36(10):1148-54.  https://doi.org/10.1017/ice.2015.163  PMID: 26204992 
  26. Chitnis AS, Caruthers PS, Rao AK, Lamb J, Lurvey R, Beau De Rochars V, et al. Outbreak of carbapenem-resistant enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol. 2012;33(10):984-92.  https://doi.org/10.1086/667738  PMID: 22961017 
  27. Birgand G, Leroy C, Nerome S, Luong Nguyen LB, Lolom I, Armand-Lefevre L, et al. Costs associated with implementation of a strict policy for controlling spread of highly resistant microorganisms in France. BMJ Open. 2016;6(1):e009029.  https://doi.org/10.1136/bmjopen-2015-009029  PMID: 26826145 
  28. Donskey CJ, Chowdhry TK, Hecker MT, Hoyen CK, Hanrahan JA, Hujer AM, et al. Effect of antibiotic therapy on the density of vancomycin-resistant enterococci in the stool of colonized patients. N Engl J Med. 2000;343(26):1925-32.  https://doi.org/10.1056/NEJM200012283432604  PMID: 11136263 
  29. Christiansen KJ, Tibbett PA, Beresford W, Pearman JW, Lee RC, Coombs GW, et al. Eradication of a large outbreak of a single strain of vanB vancomycin-resistant Enterococcus faecium at a major Australian teaching hospital. Infect Control Hosp Epidemiol. 2004;25(5):384-90.  https://doi.org/10.1086/502410  PMID: 15188843 
  30. Kurup A, Chlebicki MP, Ling ML, Koh TH, Tan KY, Lee LC, et al. Control of a hospital-wide vancomycin-resistant Enterococci outbreak. Am J Infect Control. 2008;36(3):206-11.  https://doi.org/10.1016/j.ajic.2007.06.005  PMID: 18371517 
Efficiency of different control measures for preventing carbapenemase-producing enterobacteria and glycopeptide-resistant Enterococcus faecium outbreaks: a 6-year prospective study in a French multihospital institution, January 2010 to December 2015
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Sandra+Fournier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Fournier Sandra</a>, <a href="/search?value1=Laure+Desenfant&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Desenfant Laure</a>, <a href="/search?value1=Catherine+Monteil&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Monteil Catherine</a>, <a href="/search?value1=Mich%C3%A8le+Nion-Huang&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nion-Huang Michèle</a>, <a href="/search?value1=Christian+Richard&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Richard Christian</a>, <a href="/search?value1=Vincent+Jarlier&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Jarlier Vincent</a>, <a href="/search?value1=the+AP-HP+Outbreaks+Control+Group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the AP-HP Outbreaks Control Group</a></span>. Efficiency of different control measures for preventing carbapenemase-producing enterobacteria and glycopeptide-resistant Enterococcus faecium outbreaks: a 6-year prospective study in a French multihospital institution, January 2010 to December 2015. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(8):pii=17-00078. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.8.17-00078" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.8.17-00078</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 31 Jan 2017;&nbsp;&nbsp; <span class="generated">Accepted</span>: 04 Jun 2017 </span> </p>
/content/10.2807/1560-7917.ES.2018.23.8.17-00078
/content/10.2807/1560-7917.ES.2018.23.8.17-00078
Loading

Data & Media loading...

Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error