Abstract
Background: Rapid screening of patients for colonization with carbapenemase-producing organisms (CPO), coupled with implementation of infection prevention strategies, has the potential to contain the spread of CPO.Methods: We first evaluated the performance of Xpert Carba-R assay (in comparison with other phenotypic methods) for carbapenemase detection using clinical isolates, and then used it to determine the intestinal CPO colonization in hospitalized patients. We then assessed the effectiveness of patient isolation in controlling the spread of CPO in a medical intensive care unit.Results: The Xpert Carba-R assay required the least processing time to reveal results and showed a 94.5% sensitivity and specificity in carbapenemase detection, except for IMP-8 (n = 4). During a 6-month study period, 134 patients in one ward were studied for CPO colonization and infection. Fifteen patients (11.2%) were colonized by CPO as detected by Xpert Carba-R assay, including three NDM, three IMP, and nine KPC possessing strains. The overall colonization and CPO infection rates were both 11.2% each. Isolation of patients with CPO led to a reduction in both colonization (from 28.6 to 5.6%) and infection rates (from 35.7 to 2.8%) during the study period (p < 0.05).Conclusion: Active surveillance of CPO utilizing the Xpert Carba-R assay supplemented with immediate patient isolation, proved to be an effective strategy to limit the spread of CPO in a health care setting.
Highlights
The rapid dissemination of carbapenemase-resistant organisms (CROs) has been reported worldwide, and is predominantly attributed to the production of carbapenemases (Tzouvelekis et al, 2012)
Molecular Detection of Carbapenemase Genes blaIMP, blaVIM, blaNDM, blaAIM, blaSPM, blaKPC, blaDIM, blaBIC, blaGIM, blaSIM, and blaOXA−48 genes were detected by multiplex PCR as previously described (Poirel et al, 2011). blaGES, blaNMC, blaSME, and blaIMI genes were each detected by a single primer set (Queenan and Bush, 2007)
Ten bacterial species were identified among 100 carbapenem resistant Enterobacteriaceae (CRE), including 38 Klebsiella pneumoniae, 22 Enterobacter cloacae, 20 Escherichia coli, seven K. oxytoca, four Citrobacter freundii, three Enterobacter aerogenes, two each of Serratia marcescens and K. planticola, one each of Proteus mirabilis and Providencia rettgeri
Summary
The rapid dissemination of carbapenemase-resistant organisms (CROs) has been reported worldwide, and is predominantly attributed to the production of carbapenemases (Tzouvelekis et al, 2012). Colonization by CPO may promote infection, and carriers, asymptomatic ones, may act as an important reservoir for CPO dissemination within the hospital setting. Carriers of CPO are at higher risk of acquiring a subsequent infection (Borer et al, 2012). Rapid and accurate screening for CPO colonization among hospitalized patients, coupled with implementation of infection prevention strategies, including strict isolation practices, has the potential to interrupt the spread of CPO in hospitals (Wiener-Well et al, 2010; Singh et al, 2012). Rapid screening of patients for colonization with carbapenemaseproducing organisms (CPO), coupled with implementation of infection prevention strategies, has the potential to contain the spread of CPO
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