Abstract
BackgroundCarbapenemase-producing Klebsiella pneumoniae (CPKP) has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting.Methodology/Principal FindingsEpidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R0 (average number of secondary cases per primary case in the absence of infection control) and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R0 reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%). The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8–12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented.Conclusions/SignificanceSurveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings.
Highlights
Over the past decade, carbapenem resistant Klebsiella pneumoniae is emerging as a major public health threat in many geographic areas [1,2,3,4,5]
In the past few years, mathematical modeling has been used to assess the impact of measures to control the spread of pathogens such as Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE) - within the hospital setting and improve our ability to determine the quantitative effects of individual infection control measures [13,14,15,16,17,18,19,20,21]
The present study provides important information on the estimates of Carbapenemase-producing Klebsiella pneumoniae (CPKP) transmissibility in a surgical unit and on the impact of various interventions for successful containment
Summary
Carbapenem resistant Klebsiella pneumoniae is emerging as a major public health threat in many geographic areas [1,2,3,4,5]. This type of resistance is mediated by plasmid-borne b-lactamases (carbapenemases), mainly the serine-carbapenemase KPC and the metallo-b-lactamases VIM, IMP, and NDM [4,6]. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting
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