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Intensive Care Unit Outbreak of Extended-Spectrum β-Lactamase–Producing Klebsiella Pneumoniae Controlled by Cohorting Patients and Reinforcing Infection Control Measures

Published online by Cambridge University Press:  02 January 2015

C. Laurent ,
H. Rodriguez-Villalobos ,
F. Rost ,
H. Strale ,
J.-L. Vincent ,
A. Deplano ,
M. J. Struelens  and
B. Byl
C. Laurent
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
H. Rodriguez-Villalobos
Affiliation:
Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
F. Rost
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
H. Strale
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
J.-L. Vincent
Affiliation:
Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
A. Deplano
Affiliation:
Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
M. J. Struelens
Affiliation:
Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
B. Byl*
Affiliation:
Departments of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
*
Department of Infection Control and Hospital Epidemiology, Hôpital Erasme 808, route de Lennick, Brussels, Belgium ([email protected])
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Abstract

Objective.

To describe an outbreak of extended-spectrum β-lactamase (ESBL)–producing Klebsiella pneumoniae in the intensive care units (ICUs) of a hospital and the impact of routine and reinforced infection control measures on interrupting nosocomial transmission.

Design.

Outbreak report.

Setting.

A 31-bed intensive care department (composed of 4 ICUs) in a university hospital in Belgium.

Intervention.

After routine infection control measures (based on biweekly surveillance cultures and contact precautions) failed to interrupt a 2-month outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures were implemented. The frequency of surveillance cultures was increased to daily sampling. Colonized patients were moved to a dedicated 6-bed ICU, where they received cohorted care with the support of additional nurses. Two beds were closed to new admissions in the intensive care department. Meetings between the ICU and infection control teams were held every day. Postdischarge disinfection of rooms was enforced. Broad-spectrum antibiotic use was discouraged.

Results.

Compared with a baseline rate of 0.44 cases per 1,000 patient-days for nosocomial transmission, the incidence peaked at 11.57 cases per 1,000 patient-days (October and November 2005; rate ratio for peak vs baseline, 25.46). The outbreak involved 30 patients, of whom 9 developed an infection. Bacterial genotyping disclosed that the outbreak was polyclonal, with 1 predominant genotype. Reinforced infection control measures lasted for 50 days. After the implementation of these measures, the incidence fell to 0.08 cases per 1,000 patient-days (rate ratio for after the outbreak vs during the outbreak, 0.11).

Conclusion.

These data indicate that, in an intensive care department in which routine screening and contact precautions failed to prevent and interrupt an outbreak of ESBL-producing K. pneumoniae, reinforced infection control measures controlled the outbreak without major disruption of medical care.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 517 - 524
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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