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 Enterococcus faecium (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 Klebsiella pneumoniae 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.
Highlights
Increase in bacterial resistance is nowadays one of the most important public health issues
Bundle measures comparable with those described in the present study succeeded in containing a large nationwide Carbapenemaseproducing Enterobacteriaceae (CPE) outbreak in Israel as reported by Schwaber [16,17]
Identification of efficient measures to control the spread of these organisms in hospitals is of foremost importance to limit healthcare-associated infections for which there are few treatment possibilities [18]
Summary
Increase in bacterial resistance is nowadays one of the most important public health issues. Acquired resistance to carbapenems due to carbapenemases in enterobacteria, as well as resistance to vancomycin in E. faecium, are, so far, uncommon in France as shown by the European Antimicrobial Resistance Surveillance Network [5]. These multidrugresistant pathogens share two critical features concerning their dissemination potential: (i) they are hosts of the digestive tract and are disseminated by faecal route [6], and (ii) their resistant traits are harboured on mobile element, increasing the risk of bacteria to bacteria dissemination. Based on the risk of their dissemination in the general population, these commensal species have been classified as ‘emergent extensively drug-resistant bacteria’ (eXDR) [7] by the French Committee for Public Health, which
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