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Selected Category: Gram negatives

Success in Controlling Outbreaks in an Intensive Care Unit Using CDC Toolkit Interventions

Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections

Dr. Kyle Enfield

Dr. Kyle Enfield

Guest Author: Kyle B. Enfield, MD,
Assistant Professor of Medicine,
Assistant Hospital Epidemiologist,
Medical Director, Medical Intensive Care Unit,
University of Virginia

Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are on the rise globally. These infections have limited therapeutic options, and invasive infections due to CRE are associated with a mortality rate upwards of 40 percent. A scary statistic for patients!

My institution, the University of Virginia Health System, identified our first case of CRE in August 2007. We had low level transmission with periods of improvement; however, in January 2010 we noted both an increase in CRE transmission among patients in the surgical intensive care unit (SICU), as well as a cluster of infections caused by a nosocomial pathogen new to the unit and our institution – extensively drug-resistant Acinetobacter baumannii (XDR-AB).

It was critical that we address this potential issue head-on in order to ensure positive patient outcomes and do our best to limit our institution’s exposure to CRE. After initial attempts to control these concurrent outbreaks of multidrug-resistant Gram negative pathogens using reinforced standard infection control practices failed, we implemented a bundled set of infection control interventions aimed to assess the prevalence of CRE and XDR-AB colonization or infection in the unit. The collective set of measures we implemented became recommended practice in the Centers for Disease Control and Prevention 2012 Carbapenem-resistant Enterobacteriaceae Toolkit. The interventions were developed by units in collaboration with Infection Prevention and Control and Environmental Services.

Media Reports about Drug-Resistant Infections

Categories: Antimicrobial Resistance, Gram negatives, Healthcare-associated infections, HICPAC, Long Term Care (LTC)

Arjun Srinivasan, MD

Arjun Srinivasan, MD

Author – Arjun Srinivasan, MD
CDC’s Division of Healthcare Quality Promotion

You probably have seen the media reports this week about drug-resistant infections in California healthcare facilities, specifically those in Los Angeles County. What we know, however, is that carbapenem-resistant Klebsiella pneumoniae (CRKP) actually exists in at least 36 states. Originally identified in 1999, CRKP may be present in the other 14 states as well, just not yet reported to CDC. 

CRKP is a Gram-negative bacteria and part of a family called Enterobacteriaceae. Carbapenem-resistant Enterobacteriaceae (or CRE) are able to fight off our last-resort antibiotics and have become an important public health issue resulting in high mortality (death) in patients. 

How can we stop these bugs?  CDC released prevention guidelines on multi-drug resistant organisms in 2006 and guidelines specifically targeting CRE in 2009. [See my previous blog posts on how to prevent CRE.] 

Infections in ICUs Plummeting, Too Many Remain in Hospitals and Dialysis Clinics

Categories: Antimicrobial Resistance, BSIs, CLABSI, Dialysis, Gram negatives, Healthcare-associated infections, MRSA, NHSN

Arjun Srinivasan, MD

Arjun Srinivasan, MD

Author – Arjun Srinivasan, MD
CDC’s Division of Healthcare Quality Promotion

As you know, bloodstream infections in patients with central lines can be deadly, killing as many as 1 in 4 patients who gets them. The newest edition of the CDC Vital Signs reports a major decrease in central-line associated bloodstream infections (CLABSIs) in intensive care unit (ICU) patients. This is an important triumph for patient safety and brings me a renewed sense of hope toward the elimination of HAIs. It also solidifies an expectation that infection prevention should be a priority in order to improve the safety of patients.

While progress is promising, about 60,000 bloodstream infections in patients with central lines still occurred outside of ICUs and in dialysis centers, according to our report. Much of this is preventable harm. We have to make every effort to ensure patients are protected in all healthcare facilities, all the time. So, how do we do that?
The good news is that everyone can contribute to preventing CLABSIs, no matter where the patient receives care.

Let’s Take an Antibiotic Time Out

Categories: Antibiotic use, Clostridium difficile, Gram negatives, Healthcare-associated infections

Arjun Srinivasan MD

Author - Arjun Srinivasan, MD
CDC – Medical Director, Get Smart for Healthcare Program

Over the past 2 years, I have brought together experts on antibiotic resistance to discuss how CDC can assist in efforts to improve antibiotic use in hospitals and nursing homes. My colleagues have published numerous studies demonstrating that inappropriate antibiotic use in hospitals and nursing homes results in increased resistance, worse patient outcomes, and increased costs.  It is also helping drive the national epidemic of Clostridium difficile infections.  This year, we have watched as deadly new mechanisms of antibiotic resistance were discovered in U.S. hospitals, mechanisms that will undoubtedly challenge our healthcare system and affect patient safety (see NDM-1, VIM). Clearly, we have a serious problem.

Those initial discussions with colleagues resulted in an expansion of CDC’s Get Smart programs, which target antibiotic use in outpatient clinics and pediatrician’s offices, to include a comprehensive program targeting inpatient settings.  This week, CDC launched the Get Smart for Healthcare program aimed reducing inappropriate antibiotic use in hospitals and nursing homes.  The foundation of this program is the concept that everyone plays a role in improving antibiotic use.

VIM: New Route, Same Destination

Categories: Antibiotic use, Gram negatives, Healthcare-associated infections

Alexander J. Kallen, MD, MPH

Alexander J. Kallen, MD, MPH

Author – Alexander Kallen, MD, MPH
Medical Officer
CDC’s Division of Healthcare Quality Promotion

Last week my colleague Dr. Brandi Limbago addressed the issue of carbapenem-resistant Enterobacteriaceae (CRE) and specifically enzymes called KPCs and NDM-1s that are causing the bacteria to become resistant to last-resort antibiotics. Today, CDC released a report about another enzyme causing CRE. This one is called VIM (Verona integron-encoded metallo-beta-lactamase). VIM has been found previously in a number of countries including Greece where this patient had been transferred from. View recommendations for surveillance and prevention here.

Just as Dr. Limbago mentioned last week, these enzymes are new routes to the same destination: CRE. All types of CRE are significant and emerging public health problems, regardless of their route to resistance or their country of origin. The fact is that we live in a very small world, medically speaking, and it’s not surprising that these organisms are moving from country to country. This situation simply reinforces the need for better antibiotic stewardship, transmission prevention and overall healthcare-associated infection (HAI) prevention in every hospital and practice – today.

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