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. 2020 Jul 6;9(1):102.
doi: 10.1186/s13756-020-00766-x.

Containing Carbapenemase-producing Klebsiella pneumoniae in an endemic setting

Kalliopi Spyridopoulou  1 , Mina Psichogiou  1 , Vana Sypsa  2 , Vivi Miriagou  3 , Amalia Karapanou  1 , Linos Hadjihannas  1 , Leonidas Tzouvelekis  4 , George L Daikos  5
Affiliations

Containing Carbapenemase-producing Klebsiella pneumoniae in an endemic setting

Kalliopi Spyridopoulou et al. Antimicrob Resist Infect Control. .

Abstract

Background: Carbapenemase-producing K. pneumoniae (CP-Kp) has been established as important nosocomial pathogen in most tertiary care hospitals in Greece. The aim of the present study was to examine the impact of an enhanced infection control program on the containment of CP-Kp in a haematology unit where the incidence of CP-Kp infections was high.

Methods: The study was conducted from June 2011 to December 2014 in a haematology unit of a tertiary-care 500-bed hospital located in Athens, Greece. A bundled intervention (active surveillance cultures, separation of carriers from non-carriers, assignment of dedicated nursing staff, contact precautions, environmental cleaning, and promotion of hand hygiene) was tested whether would reduce colonization and infection caused by CP-Kp.

Results: A total of 2507 rectal swabs were obtained; 1199 upon admission from June 2011 to June 2013 and 1307 during hospitalization from June 2011 to December 2012. During intervention the admission prevalence of CP-Kp colonization (p < 0.001 for linear trend), the hospitalization prevalence (p = 0.001 for linear trend) and the incidence rate of CP-Kp colonization (p = 0.072 for linear trend) were declining. Application of segmented linear regression revealed that both the change in the level of CP-Kp BSI incidence rates (p = 0.001) as well as the difference between pre- and post-intervention slopes were statistically significant (p < 0.001).

Conclusions: A bundled intervention including active surveillance cultures on admission can attain maximum containment of CP-Kp colonization and infection in endemic acute healthcare settings.

Keywords: Active surveillance; Carbapenemases; Hospital-acquired infection; Infection control; Klebsiella pneumoniae.

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Conflict of interest statement

All authors report no competing interests relevant to this article.

Figures

Fig. 1
Fig. 1
Intervention measures according to time period
Fig. 2
Fig. 2
Monthly prevalence of CP-Kp colonization on admission during three periods indicated by the vertical dashed lines: May 2011 (pre-intervention), June 2011–December 2012 (implementation of the intervention including surveillance cultures obtained on admission, weekly and on discharge) and January–June 2013 (surveillance cultures only on admission). The solid circles dots indicate the observed monthly prevalence on admission and the dashed line is the corresponding fitted regression line for the period June 2011–December 2012
Fig. 3
Fig. 3
Monthly prevalence of CP-Kp colonization. The vertical dashed line indicates the initiation of the intervention (June 2011). The solid circles indicate the observed monthly prevalence and the solid line is the corresponding fitted regression line for the period June 2011–December 2012. After December 2012, only prevalence on admission was assessed
Fig. 4
Fig. 4
Incidence rate of CP-Kp colonization per month (solid circles: monthly incidence rates, solid line: lowess smoothing, dashed line: fitted linear regression line)
Fig. 5
Fig. 5
BSI incidence rate during 2010–2014 (solid circles: BSI incidence rates per 3-month periods, dashed vertical line: initiation of intervention, solid lines: fitted regression lines for the periods pre- and post-intervention)
Fig. 6
Fig. 6
or supplementary. BSI incidence rate (all pathogens) during 2010–2014 (solid circles: BSI incidence rates per 3-month periods, dashed vertical line: initiation of intervention, solid lines: fitted regression line)
See this image and copyright information in PMC

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