Admission screening and cohort care decrease carbapenem resistant enterobacteriaceae in Vietnamese pediatric ICU\u2019s

K Garpvall,A Edman,S Modeen,H T Le,L Lagercrantz,S Linnros,P H Phuc,H Hanberger,D Tk Khu,T N Quốc,L Olson,D Mucchiano,D M Tran,M Larsson,T Huong,N K Le,N T B Hoang,V Duong

doi:10.1186/s13756-021-00994-9

Abstract

ObjectivesTo assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU’s) at the Vietnamese National Children’s Hospital.MethodCRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status.ResultsCRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR − 3.2, p < 0.005) from 90% in period 2 (highest) to 48% in period 8 (last period). Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI, n = 20 (14%) vs. n = 2 (2%), longer hospital stays, 3.26 vs. 2.37 weeks, and higher total treatment costs, 2852 vs. 2295 USD.ConclusionAdmission CRE screening and cohort care in pediatric ICU’s significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.

Highlights

Antibiotic resistance is resulting in increased morbidity, mortality and healthcare costs [1]
Baseline Carbapenem Resistant Enterobacteriaceae (CRE) point prevalence survey Baseline CRE PPS was performed on the 20th of March 2018 in the NICU: 21st in the Surgical Intensive Care Unit (SICU) and 22nd in the Pediatric Intensive Care Unit (PICU). 103/134 patients (76.9%) were CRE colonized: NICU 79.4% (54/68), SICU 60.7% (17/28) and PICU 84.2% (32/38) (Table 1)
Admission CRE screening A total of 941 patients were CRE screened at admission to the intensive care units (ICU’s). 337 (35.8%) were CRE colonized: NICU 39.6% (165/417), PICU 40.6% (91/224) and SICU 27,0% (81/300)

Summary

Introduction

Antibiotic resistance is resulting in increased morbidity, mortality and healthcare costs [1]. Hospital acquired infections (HAI) with Carbapenem Resistant Enterobacteriaceae (CRE) are resistant to most antibiotics [4, 5] and very difficult to treat even with last resort antibiotics including tigecycline, gentamicin, amikacin and colistin [4, 6]. Garpvall et al Antimicrob Resist Infect Control (2021) 10:128. CRE colonization and HAI are common in Vietnamese intensive care units (ICU’s) [2,7,8]. CRE colonized patients with HAI has high mortality [7,9,10,6,9,10,11,12]

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Discussion

Conclusion