Containment of a Country-wide Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Israeli Hospitals via a Nationally Implemented Intervention
ABSTRACT During 2006, Israeli hospitals faced a clonal outbreak of carbapenem-resistant Klebsiella pneumoniae that was not controlled by local measures. A nationwide intervention was launched to contain the outbreak and to introduce a strategy to control future dissemination of antibiotic-resistant bacteria in hospitals.
In March 2007, the Ministry of Health issued guidelines mandating physical separation of hospitalized carriers of carbapenem-resistant Enterobacteriaceae (CRE) and dedicated staffing and appointed a professional task force charged with containment. The task force paid site visits at acute-care hospitals, evaluated infection-control policies and laboratory methods, supervised adherence to the guidelines via daily census reports on carriers and their conditions of isolation, provided daily feedback on performance to hospital directors, and intervened additionally when necessary. The initial intervention period was 1 April 2007-31 May 2008. The primary outcome measure was incidence of clinically diagnosed nosocomial CRE cases.
By 31 March 2007, 1275 patients were affected in 27 hospitals (175 cases per 1 million population). Prior to the intervention, the monthly incidence of nosocomial CRE was 55.5 cases per 100,000 patient-days. With the intervention, the continuous increase in the incidence of CRE acquisition was halted, and by May 2008, the number of new monthly cases was reduced to 11.7 cases per 100,000 patient-days (P<.001). There was a direct correlation between compliance with isolation guidelines and success in containment of transmission (P=.02). Compliance neutralized the effect of carrier prevalence on new incidence (P=.03).
A centrally coordinated intervention succeeded in containing a nationwide CRE outbreak after local measures failed. The intervention demonstrates the importance of strategic planning and national oversight in combating antimicrobial resistance.
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- "The emergence and dissemination of carbapenem-resistant Gram-negative pathogens including Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacteriaceae is a significant contributor to patient morbidity and mortality (Patel et al., 2008; Schwaber et al., 2008; Lautenbach et al., 2009, 2010; Marchaim et al., 2011). Despite radical efforts in infection control (Schwaber et al., 2011) and improvements in rapid molecular diagnostics (Centers for Disease Control and Prevention, 2009; Nordmann et al., 2012c), carbapenem-resistant Gram-negative bacilli remain a formidable threat as few antimicrobial agents are reliably active and very little is expected to be available in the near future. "
ABSTRACT: Carbapenems, once considered the last line of defense against of serious infections with Enterobacteriaceae, are threatened with extinction. The increasing isolation of carbapenem-resistant Gram-negative pathogens is forcing practitioners to rely on uncertain alternatives. As little as 5 years ago, reports of carbapenem resistance in Enterobacteriaceae, common causes of both community and healthcare-associated infections, were sporadic and primarily limited to case reports, tertiary care centers, intensive care units, and outbreak settings. Carbapenem resistance mediated by β-lactamases, or carbapenemases, has become widespread and with the paucity of reliable antimicrobials available or in development, international focus has shifted to early detection and infection control. However, as reports of Klebsiella pneumoniae carbapenemases, New Delhi metallo-β-lactamase-1, and more recently OXA-48 (oxacillinase-48) become more common and with the conveniences of travel, the assumption that infections with highly resistant Gram-negative pathogens are limited to the infirmed and the heavily antibiotic and healthcare exposed are quickly being dispelled. Herein, we provide a status report describing the increasing challenges clinicians are facing and forecast the "stormy waters" ahead.Frontiers in Microbiology 03/2013; 4:48. DOI:10.3389/fmicb.2013.00048 · 3.94 Impact Factor
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- "Cette politique a fait la preuve de son efficacité pour la maîtrise des ERV en France, non seulement pour des phénomènes épidémiques limités, mais aussi pour des épidémies de grande ampleur comme au CHU de Clermont-Ferrand ou en Lorraine. Tout récemment, Israël a présenté des résultats spectaculaires pour la maîtrise d'une situation qui paraissait très compromise avec une dissémination des EPC dans la majorité des hôpitaux israéliens . La principale mesure mise en oeuvre était un cohorting des cas identifiés sur les seuls prélèvements cliniques dans tous les hôpitaux du pays. "
ABSTRACT: The incidence of extended-spectrum β-lactamase-producing Enterobacteriacae (ESBLPE) is increasing, due to the emergence of CTX-M ESBL Escherichia coli, together with the resurgence of classical ESBLPE. Carbapenemase-producing Enterobacteriaceae (CPE) rapidly disseminate in many countries, but still are emergent in France, with small outbreaks originating from repatriated patients. These multiply- or highly-resistant Gram-negative bacteria (HRGNB) pose a serious threat for the upcoming years, in the community (ESBLPE) and in the healthcare setting (ESBLPE and CPE). Contrary to MRSA, controlling the spread of ESBLPE must include strict infection control measures together with sharp decreasing of antimicrobial use. For ESBLPE, standard and contact precautions should stem their dissemination. For HRGNB, a strict control policy, similar to that applied for vancomycin-resistant enterococci (VRE), can prevent the establishment of these strains in France. Awareness is urgently needed from healthcare authorities, healthcare professionals, public and medias.06/2011; 13(2). DOI:10.1016/j.antinf.2011.03.006
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ABSTRACT: Stephen Harbarth and colleagues argue that the International Health Regulations (IHR) should be applied to the global health threat of antimicrobial resistance.PLoS Medicine 04/2011; 8(4):e1001022. DOI:10.1371/journal.pmed.1001022 · 14.00 Impact Factor