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Intensive care unit outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae controlled by cohorting patients and reinforcing infection control measures.
Infect Control Hosp Epidemiol. 2008 Jun; 29(6):517-24.IC

Abstract

OBJECTIVE

To describe an outbreak of extended-spectrum beta-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.

Authors+Show Affiliations

Department of Infection Control and Epidemiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18510461

Citation

Laurent, C, et al. "Intensive Care Unit Outbreak of Extended-spectrum Beta-lactamase-producing Klebsiella Pneumoniae Controlled By Cohorting Patients and Reinforcing Infection Control Measures." Infection Control and Hospital Epidemiology, vol. 29, no. 6, 2008, pp. 517-24.
Laurent C, Rodriguez-Villalobos H, Rost F, et al. Intensive care unit outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae controlled by cohorting patients and reinforcing infection control measures. Infect Control Hosp Epidemiol. 2008;29(6):517-24.
Laurent, C., Rodriguez-Villalobos, H., Rost, F., Strale, H., Vincent, J. L., Deplano, A., Struelens, M. J., & Byl, B. (2008). Intensive care unit outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae controlled by cohorting patients and reinforcing infection control measures. Infection Control and Hospital Epidemiology, 29(6), 517-24. https://doi.org/10.1086/588004
Laurent C, et al. Intensive Care Unit Outbreak of Extended-spectrum Beta-lactamase-producing Klebsiella Pneumoniae Controlled By Cohorting Patients and Reinforcing Infection Control Measures. Infect Control Hosp Epidemiol. 2008;29(6):517-24. PubMed PMID: 18510461.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensive care unit outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae controlled by cohorting patients and reinforcing infection control measures. AU - Laurent,C, AU - Rodriguez-Villalobos,H, AU - Rost,F, AU - Strale,H, AU - Vincent,J-L, AU - Deplano,A, AU - Struelens,M J, AU - Byl,B, PY - 2008/5/31/pubmed PY - 2008/7/23/medline PY - 2008/5/31/entrez SP - 517 EP - 24 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 29 IS - 6 N2 - OBJECTIVE: To describe an outbreak of extended-spectrum beta-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. SN - 0899-823X UR - https://www.unboundmedicine.com/medline/citation/18510461/Intensive_care_unit_outbreak_of_extended_spectrum_beta_lactamase_producing_Klebsiella_pneumoniae_controlled_by_cohorting_patients_and_reinforcing_infection_control_measures_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=18510461.ui DB - PRIME DP - Unbound Medicine ER -