Enfield Kyle B, Huq Nujhat N, Gosseling Megan F, Low Darla J, Hazen Kevin C, Toney Denise M, Slitt Gavin, Zapata Heidi J, Cox Heather L, Lewis Jessica D, Kundzins John R, Mathers Amy J, Sifri Costi D
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia.
Infect Control Hosp Epidemiol. 2014 Jul;35(7):810-7. doi: 10.1086/676857. Epub 2014 May 15.
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).
Before-after intervention study.
Fifteen-bed surgical trauma intensive care unit (ICU).
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.
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.
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.
我们描述了强化感染控制措施的效果，包括疾病控制与预防中心2012年耐碳青霉烯类肠杆菌科细菌（CRE）工具包中推荐的措施，以控制产碳青霉烯酶肠杆菌科细菌（CPE）和广泛耐药鲍曼不动杆菌（XDR-AB）的并发暴发。
干预前后研究。
拥有15张床位的外科创伤重症监护病房（ICU）。
我们调查了2009年4月至2010年3月期间，强化感染控制措施对某ICU中CPE和XDR-AB感染聚集情况的影响。采用聚合酶链反应检测CRE中blaKPC和耐药质粒的存在情况。进行脉冲场凝胶电泳以评估XDR-AB的克隆性。针对CPE的持续传播和XDR-AB的新暴发实施了强化感染控制措施。通过比较这些措施实施前后CPE和XDR-AB的发病率（IR）来评估效果。
强化措施实施前12个月的CPE发病率为每1000患者日7.77例，而实施前3个月的XDR-AB发病率为每1000患者日6.79例。所有检测的CPE均共享地方性blaKPC耐药质粒，7株XDR-AB分离株中有6株为克隆性。实施强化感染控制措施后，CPE发病率降至每1000患者日1.22例（P = 0.001），且未再发现XDR-AB病例。
采用疾病控制与预防中心2012年CRE工具包中描述的感染控制措施与CPE发病率降低及XDR-AB传播中断相关。
