Abstract
ObjectiveTo determine whether infection-prevention and control (IPC) interventions can reduce the colonisation and infection of intensive care unit (ICU)-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) in a general ICU ward in China.MethodsWe used a quasi-experimental before-and-after study design. The study was conducted in 4 stages: baseline period, January 2013–June 2013; IPC interventions period including de-escalation and targeted bundle interventions, July 2013–June 2014; modified IPC interventions period, July 2014–June 2015; and follow-up period, July 2015–June 2016. We used modified de-escalation interventions according to patient-risk assessments to prevent the transmission of CRKP.ResultsA total of 629 patients were enrolled in study. The incidence of ICU-acquired CRKP colonisation/infection was 10.08 (4.43–16.43) per 1000 ICU patient-days during the baseline period, and significantly decreased early during the IPC interventions, but the colonisation/infections reappeared in April 2014. During the modified IPC intervention and follow-up periods, the incidence of ICU-acquired CRKP colonisations/infections reduced to 5.62 (0.69–6.34) and 2.84 (2.80–2.89), respectively, with ongoing admission of cases with previously acquired CRKP. The incidence of ICU-acquired CRKP catheter-related bloodstream infections decreased from 2.54 during the baseline period to 0.41 during the follow-up period. The incidence of ventilator-associated pneumonia and skin and soft tissue infections showed a downward trend from 2.84 to 0.41 and from 3.4 to 0.47, respectively, with slight fluctuations.ConclusionsComprehensive IPC interventions including de-escalation and targeted bundle interventions showed a significant reduction in ICU-acquired CRKP colonisations/infections, despite ongoing admission of patients colonised/infected with CRKP.
Highlights
Klebsiella pneumoniae infections are a serious contemporary problem in intensive care units (ICUs) worldwide and primarily affect critical and immunocompromised patients [1]
Antimicrobial susceptibility testing, and clinical data collection When patients were admitted to the ICU ward, pathogens screening had been carried out immediately and the second Active surveillance cultures (ASC) had been done within a week
The first stage was a 6-month baseline period included patients who were admitted to the ICU during January 2013–June 2013, during which no intervention was performed and regular culture surveys were conducted to measure the prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonisation/infection
Summary
Settings and ethics statement The tertiary-level ICU of the Ruijin Hospital, Shanghai Jiao Tong University School of Medicine in Shanghai, consists of 12 beds including 8 private rooms and 2 double-occupancy rooms, and can hold approximately 180–250 critically ill patients annually. Antimicrobial susceptibility testing, and clinical data collection When patients were admitted to the ICU ward, pathogens screening had been carried out immediately and the second ASCs had been done within a week. Routine and active surveillance cultures (ASCs) from various samples (nasopharyngeal swabs, sputum, endotracheal aspirate, urinary tract, and other possible infection sites) had been collected to monitor the incidence of CRKP colonisation/infection twice a week on Monday and Thursday. Infection-control interventions and data collection The study was implemented in 4 stages (Table 1). The first stage was a 6-month baseline period included patients who were admitted to the ICU during January 2013–June 2013, during which no intervention was performed and regular culture surveys were conducted to measure the prevalence of CRKP colonisation/infection.
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