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. 2020 Aug 25;9(9):2744.
doi: 10.3390/jcm9092744.

Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?

Beatrice Tiri  1 , Emanuela Sensi  2 , Viola Marsiliani  2 , Mizar Cantarini  2 , Giulia Priante  3 , Carlo Vernelli  3 , Lucia Assunta Martella  3 , Monya Costantini  4 , Alessandro Mariottini  5 , Paolo Andreani  5 , Paolo Bruzzone  6 , Fabio Suadoni  7 , Marsilio Francucci  8 , Roberto Cirocchi  9 , Stefano Cappanera  1
Affiliations

Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?

Beatrice Tiri et al. J Clin Med. .

Abstract

The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the "daily-ICU round strategy" and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March-April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4-5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.

Keywords: COVID-19; CRE colonization; antimicrobial stewardship; carbapenem-resistant Klebsiella pneumoniae; intensive care unit.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The trend of incidence of primary Carbapenem-Resistant Enterobacteriaceae (CRE) and acquisition CRE in intensive care unit (ICU).
Figure 2
Figure 2
The trend of incidence of CRE acquisition colonization.
Figure 3
Figure 3
Data about the acute respiratory distress syndrome (ARDS) coronavirus disease 2019 (COVID-19) patients pronate and not pronate and CRE colonization.
See this image and copyright information in PMC

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