Is cohorting the only solution to control carbapenemase-producing Enterobacteriaceae outbreaks? A single-centre experience

C Legeay; V Thépot-Seegers; H Pailhoriès; D Hilliquin; J-R Zahar

doi:10.1016/j.jhin.2018.02.003

Is cohorting the only solution to control carbapenemase-producing Enterobacteriaceae outbreaks? A single-centre experience

J Hosp Infect. 2018 Aug;99(4):390-395. doi: 10.1016/j.jhin.2018.02.003. Epub 2018 Feb 10.

Authors

C Legeay¹, V Thépot-Seegers², H Pailhoriès³, D Hilliquin⁴, J-R Zahar⁵

Affiliations

¹ Infection Control and Prevention Unit, CHU d'Angers, University of Angers, Angers, France. Electronic address: [email protected].
² Data Management Research Department DRCI, Angers Hospital and SFR ICAT, University of Angers, Angers, France.
³ Center for Research in Cancerology & Immunology Nantes-Angers, Institut National de la Santé et de la Recherche Médicale, Université de Nantes, Université d'Angers, Angers, France; Laboratoire de Bactériologie, IRIS, CHU d'Angers, Angers, France.
⁴ Infection Control and Prevention Unit, CHU d'Angers, University of Angers, Angers, France.
⁵ Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France; IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France.

PMID: 29438727
DOI: 10.1016/j.jhin.2018.02.003

Abstract

Background: Carbapenemase-producing Enterobacteriaceae (CPE) are a major health issue. Cohorting may help to control spread of CPEs in hospitals, but is expensive and hard to implement.

Aim: To identify ward variables associated with CPE in-hospital transmission in a hospital where cohorting has never been implemented.

Methods: Cohort prospective study, comparing 14-consecutive-day periods regarding in-hospital transmission. Each period met the two following conditions: (i) CPE carriers/infected admitted for ≥48 h; (ii) 80% of relative contact patients were screened at least twice. Periods (a) with no acquired CPE case among relative contact patients were compared to periods (b) during which one or more CPE case acquisition was identified. Variables potentially associated with CPE transmission were assessed: colonization pressure, caregiver:patient ratio, hand hygiene compliance, hydro-alcoholic product consumption, antibiotic consumption, and infection control team (ICT) involvement on the ward.

Findings: Sixty-eight periods of two consecutive weeks were included, 18 (26.5%) included at least one CPE case acquisition. By multivariate analysis, colonization pressure (odds ratio: 1.12; 95% confidence interval: 1.0-1.25; P = 0.042) and antibiotic consumption (2.41; 1.02-5.66; P = 0.044) were associated with CPE in-hospital transmission. Caregiver:patient ratio potentiated both these variables, suggesting a role for understaffing in CPE transmission.

Conclusion: Understanding ward variables associated with CPE spread can help design suitable solutions. Colonization pressure and antibiotic consumption seems to be driving in-hospital transmission, along with caregiver:patient ratio. In presence of high colonization pressure, dedicated healthcare workers for managing CPE patients should be implemented. Co-ordination between ICT and antimicrobial stewardship team is also crucial to prevent CPE spread.

Keywords: Carbapenemase; Colonization pressure; Enterobacteriaceae; Outbreak.

MeSH terms

Adult
Aged
Aged, 80 and over
Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
Cross Infection / epidemiology*
Cross Infection / microbiology
Cross Infection / prevention & control
Cross Infection / transmission
Disease Outbreaks*
Disease Transmission, Infectious / prevention & control*
Enterobacteriaceae Infections / epidemiology*
Enterobacteriaceae Infections / microbiology
Enterobacteriaceae Infections / prevention & control
Enterobacteriaceae Infections / transmission
Female
Humans
Infection Control / methods*
Male
Middle Aged
Prospective Studies
Young Adult