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Control of Simultaneous Outbreaks of Carbapenemase-Producing Enterobacteriaceae and Extensively Drug-Resistant Acinetobacter baumannii Infection in an Intensive Care Unit Using Interventions Promoted in the Centers for Disease Control and Prevention 2012 Carbapenemase-Resistant Enterobacteriaceae Toolkit

Published online by Cambridge University Press:  10 May 2016

Kyle B. Enfield ,
Nujhat N. Huq ,
Megan F. Gosseling ,
Darla J. Low ,
Kevin C. Hazen ,
Denise M. Toney ,
Gavin Slitt ,
Heidi J. Zapata ,
Heather L. Cox  and
Jessica D. Lewis
...Show all authors
Kyle B. Enfield
Affiliation:
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia
Nujhat N. Huq
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Megan F. Gosseling
Affiliation:
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia
Darla J. Low
Affiliation:
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia
Kevin C. Hazen
Affiliation:
Department of Pathology, University of Virginia Health System, Charlottesville, Virginia
Denise M. Toney
Affiliation:
Division of Consolidated Laboratory Services, Department of General Services, Commonwealth of Virginia, Richmond, Virginia
Gavin Slitt
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Heidi J. Zapata
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Heather L. Cox
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Jessica D. Lewis
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
John R. Kundzins
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Amy J. Mathers
Affiliation:
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
Costi D. Sifri*
Affiliation:
Office of Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, Charlottesville, Virginia Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia
*
Division of Infectious Diseases and International Health, Hospital Epidemiology/Infection Prevention and Control, University of Virginia Health System, P.O. Box 800473, Charlottesville, VA 22908 ([email protected]).
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Objective

We describe the efficacy of enhanced infection control measures, including those recommended in the Centers for Disease Control and Prevention’s 2012 carbapenem-resistant Enterobacteriaceae (CRE) toolkit, to control concurrent outbreaks of carbapenemase-producing Enterobacteriaceae (CPE) and extensively drug-resistant Acinetobacter baumannii (XDR-AB).

Design

Before-after intervention study.

Setting

Fifteen-bed surgical trauma intensive care unit (ICU).

Methods

We investigated the impact of enhanced infection control measures in response to clusters of CPE and XDR-AB infections in an ICU from April 2009 to March 2010. Polymerase chain reaction was used to detect the presence of blaKPC and resistance plasmids in CRE. Pulsed-field gel electrophoresis was performed to assess XDR-AB clonality. Enhanced infection-control measures were implemented in response to ongoing transmission of CPE and a new outbreak of XDR-AB. Efficacy was evaluated by comparing the incidence rate (IR) of CPE and XDR-AB before and after the implementation of these measures.

Results

The IR of CPE for the 12 months before the implementation of enhanced measures was 7.77 cases per 1,000 patient-days, whereas the IR of XDR-AB for the 3 months before implementation was 6.79 cases per 1,000 patient-days. All examined CPE shared endemic blaKPC resistance plasmids, and 6 of the 7 XDR-AB isolates were clonal. Following institution of enhanced infection control measures, the CPE IR decreased to 1.22 cases per 1,000 patient-days (P = .001), and no more cases of XDR-AB were identified.

Conclusions

Use of infection control measures described in the Centers for Disease Control and Prevention’s 2012 CRE toolkit was associated with a reduction in the IR of CPE and an interruption in XDR-AB transmission.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 7 , July 2014 , pp. 810 - 817
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

a

K.B.E. and N.N.H. contributed equally to this article.

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