Validation and Extrapolation of a Multimodal Infection Prevention and Control Intervention on Carbapenem-Resistant Klebsiella pneumoniae in an Epidemic Region: A Historical Control Quasi-Experimental Study.

Yunqi Dai,Xiaoli Wang,Feng Wang,Bin Tang,Tianjiao Meng,Ying Du,Yuzhen Qiu,Hongping Qu,Ruoming Tan,Jialin Liu

doi:10.3389/fmed.2021.692813

Yunqi Dai, Xiaoli Wang + Show 8 more

Open Access

https://doi.org/10.3389/fmed.2021.692813

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Journal: Frontiers in medicine	Publication Date: Jul 7, 2021
Citations: 3	License type: CC BY 4.0

Affiliation: Ruijin Hospital

Abstract

Objective: To verify the effects of comprehensive infection prevention and control (IPC) interventions for the prevention of the cross-transmission of carbapenem-resistant Klebsiella pneumoniae (CRKP) within intensive care units (ICUs) in an epidemic region.Methods: A historical control, quasi-experimental design was performed. The study was conducted between January 2017 and December 2019, following the implementation of a multimodal IPC bundle. The baseline period was established from January 2013 to June 2013, when only basic IPC measures were applied.Results: A total of 748 patients were enrolled during the entire study. The incidence of ICU-acquired CRKP colonization/infection was 1.16 per 1,000 patient-days during the intervention period, compared with 10.19 per 1,000 patient-days during the baseline period (p = 0.002). The slope of the monthly incidence of CRKP at admission showed an increasing trend (p = 0.03). The incidence of ICU-acquired catheter-related bloodstream infections caused by CRKP decreased from 2.54 to 0.96 per 1,000 central-line-days (p = 0.08). Compliance with contact precautions and terminal room disinfection improved during the intervention period. All environmental surface culture samples acquired after terminal room disinfection were negative for CRKP.Conclusion: Our findings suggest that in epidemic settings, multimodal IPC intervention strategies and consistent monitoring of compliance, may limit the spread of CRKP in ICUs.

Highlights

At the turn of the century, the surge in antimicrobial resistance (AMR) became a global public health threat
The incidence of intensive care units (ICUs)-acquired catheter-related bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) decreased from 2.54 to 0.96 per 1,000 central-line-days (p = 0.08)
Infections caused by CRKP are challenging to treat because CRKP is resistant to a wide range of antibiotics, including carbapenems and colistin, which are last-resort drugs used in clinical practice [6]

Summary

Introduction

At the turn of the century, the surge in antimicrobial resistance (AMR) became a global public health threat. Klebsiella pneumoniae (KP) can cause numerous infections in hospitals, long-term care facilities, and communities worldwide. The 2019 World Health Organization (WHO) global priority pathogens list for the research and development of new antibiotics ranks carbapenem-resistant Enterobacteriaceae (CRE) within the critical priority category. Patients in intensive care units (ICUs) are at high risk for acquiring CRKP due to previous antibiotics exposure (carbapenem, tigecycline, or β-lactam/β-lactamases inhibitor), invasive procedures, and surgical operations [2]. Infections caused by CRKP are challenging to treat because CRKP is resistant to a wide range of antibiotics, including carbapenems and colistin, which are last-resort drugs used in clinical practice [6]. Proper and effective infection prevention and control (IPC) interventions are urgently necessary to reduce the incidence of CRKP acquisition in ICU settings [8]

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