Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece.
PLoS One. 2012;7(7):e41068. doi: 10.1371/journal.pone.0041068. Epub 2012 Jul 31.
Carbapenemase-producing Klebsiella pneumoniae (CPKP) has been established as important nosocomial pathogen in many geographic regions. Transmission from patient to patient via the hands of healthcare workers is the main route of spread in the acute-care setting.
METHODOLOGY/PRINCIPAL FINDINGS: Epidemiological and infection control data were recorded during a prospective observational study conducted in a surgical unit of a tertiary-care hospital in Greece. Surveillance culture for CPKP were obtained from all patients upon admission and weekly thereafter. The Ross-Macdonald model for vector-borne diseases was applied to obtain estimates for the basic reproduction number R(0) (average number of secondary cases per primary case in the absence of infection control) and assess the impact of infection control measures on CPKP containment in endemic and hyperendemic settings. Eighteen of 850 patients were colonized with CPKP on admission and 51 acquired CPKP during hospilazation. R(0) reached 2 and exceeded unity for long periods of time under the observed hand hygiene compliance (21%). The minimum hand hygiene compliance level necessary to control transmission was 50%. Reduction of 60% to 90% in colonized patients on admission, through active surveillance culture, contact precautions and isolation/cohorting, in combination with 60% compliance in hand hygiene would result in rapid decline in CPKP prevalence within 8-12 weeks. Antibiotics restrictions did not have a substantial benefit when an aggressive control strategy was implemented.
CONCLUSIONS/SIGNIFICANCE: Surveillance culture on admission and isolation/cohorting of colonized patients coupled with moderate hand hygiene compliance and contact precautions may lead to rapid control of CPKP in endemic and hyperendemic healthcare settings.
产碳青霉烯酶肺炎克雷伯菌（CPKP）已成为许多地理区域中重要的医院获得性病原体。在急性护理环境中，医护人员经手将其在患者之间传播是主要的传播途径。
方法/主要发现：在希腊一家三级保健医院的外科病房进行的一项前瞻性观察研究中记录了流行病学和感染控制数据。所有入院患者均接受了 CPKP 的监测培养，并在此后每周进行一次。应用罗斯-麦克唐纳（Ross-Macdonald）疾病传播模型来获得基本繁殖数 R(0)（在没有感染控制的情况下，每例原发性病例的继发性病例平均数）的估计值，并评估感染控制措施对流行和高度流行环境中 CPKP 控制的影响。在 850 名患者中，有 18 名在入院时定植了 CPKP，有 51 名患者在住院期间获得了 CPKP。在观察到的手卫生依从率（21%）下，R(0)达到 2 并长时间超过 1。要控制传播，手卫生的最低依从率必须达到 50%。通过主动监测培养、接触预防和隔离/分组，将入院时定植的患者减少 60%至 90%，同时手卫生的依从率达到 60%，将导致 CPKP 的流行率在 8-12 周内迅速下降。当实施积极的控制策略时，抗生素限制没有带来实质性的益处。
结论/意义：入院时的监测培养以及定植患者的隔离/分组，加上适度的手卫生依从性和接触预防措施，可能会导致流行和高度流行的医疗保健环境中 CPKP 的迅速控制。
