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The COVID-19 pandemic led to an initial increase in the incidence of carbapenem-resistant Enterobacterales (CRE) from clinical cultures in South-East Asia hospitals, which was unsustained as the pandemic progressed. Conversely, there was a decrease in CRE incidence from surveillance cultures and overall combined incidence. Further studies are needed for future pandemic preparedness.
Objectives: The increase in carbapenemase-producing organism (CPO) transmission among hospitalized patients is a growing concern. Studies investigating the transmission of CPO to epidemiologically linked contacts are scarce. We conducted an interim subgroup analysis of the ongoing multicenter household transmission of CPO in Singapore (CaPES-C) study to identify the acquisition rate of CPO among epidemiologically linked contacts of hospitalized CPO patients. Methods: This multicenter prospective cohort study was conducted between January and December 2021. We recruited CPO-positive patients and their epidemiologically linked contacts. Stool samples were collected from the patients at baseline, day 3, day 7, and at weeks 2, 3, 4, 5, 6, 12, 24, 36, and 48. Additionally, a sample was collected at the time of discharge from the hospital. Xpert Carba-R test was used to detect CPO genotypes in the stool samples. In this interim analysis, we calculated the acquisition rate of CPO among the epidemiologically linked hospital contacts of CPO positive patients using Stata version 15 software. Results: We recruited 22 (56.4%) CPO-positive index patients [blaNDM, n = 7 (31.8%); blaIMP, n = 3 (13.6%); blaOXA-48, n = 10 (45.5%), others, n = 2 (9.1%)] and 14 (35.9%) epidemiologically linked hospital contacts. The median age of CPO-positive patients was 72.5 years (IQR, 62–82) and 15 (68.2%) were female. The median age for the epidemiologically linked contacts was 82.5 years (IQR, 70–85) and 4 (28.6%) were female. After 1,082 patient days, 2 (14.3%) epidemiologically linked contacts tested positive for CPO giving an acquisition rate of 1.85 per 1,000 patient days (95% CI, 0.46 – 7.39). One of these participants acquired a concordant genotype (blaOXA-48) at day 7 and the other acquired a discordant genotype (CPO positive index, blaIMP; epidemiologically linked contact, blaNDM) at week 12 of follow-up. Conclusions: This small interim analysis revealed a high conversion rate among epidemiologically linked hospital contacts. A larger study is needed to understand the influence of genotypes, hospital environment, and human behavior on the transmission of CPO in hospitals.
Objectives: Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are nosocomial pathogens, and control of CP-CRE transmission is one of the most important infection control issues healthcare organizations face today. Increasing colonization acquisition and clinical infections of CP-CRE occurred in our institution in 2019. In this observational study, we monitored CP-CRE acquisition following implementation of multimodal control measures, and we describe the impact of this intervention on clinical infections. Methods: Increased hospital-acquired CP-CRE colonization and clinical infections were observed in early 2019. Increased CP-CRE surveillance was implemented to include CP-CRE contacts, patients with lengths of stay >7 days, patients with a recent history of hospitalization in other hospitals, and renal dialysis patients. The following interventions were also implemented: (1) isolation or placing CP-CRE patients in cohorts in a designated multidrug-resistant organism (MDRO) ward; (2) emphasis on hand hygiene and contact precautions; (3) mandatory use of gown and gloves for predefined ‘high-risk’ nursing activities, including diaper changing, toilet assistance, wound dressing, and handling urine or stool; (4) enhanced environmental and equipment cleaning; (5) regular audit and feedback regarding compliance; and (6) weekly feedback on ward-level CP-CRE acquisition. CP-CRE
colonization cases and clinical infections were tracked by infection prevention and control nurses. Results: The hospital-acquired CP-CRE colonization rate was 4.39 per 10,000 patient days in 2019; it decreased slightly to 3.61 in 2020 and remained steady at 3.77 in 2021. The predominant CP-CRE genes were NDM, OXA-48–like, and KPC. There were 12 hospital-acquired CP-CRE infections in 2019, a rate of 0.37 per 10,000 patient days. This incidence decreased to 6 infections in 2020 and 3 infections in 2021, with corresponding infection rates of 0.19 and 0.09 per 10,000 patient days, respectively. Conclusions: Control of CP-CRE remains extremely challenging in hospitals with multibed open wards. A bundle approach to infection control showed a gradual reduction in CP-CRE cases, with a significant impact on the prevention of clinical infections.
To investigate the molecular epidemiology of carbapenem-resistant Acinetobacter baumannii-calcoaceticus complex isolates in a tertiary care hospital where the prevalence of carbapenem resistance among these organisms is high.
The study was a prospective, observational study performed during an 8-month period (May 1 through December 31, 2004). A. baumannii isolates recovered from all clinical samples during the study period were included in the study. Antibiotic susceptibility testing was performed using the disk diffusion method, and all carbapenem-resistant strains were typed by a polymerase chain reaction-based typing method.
An 800-bed hospital in Singapore.
More than half of recovered isolates were clonally unrelated, with the remaining isolates grouped into 4 genotypes.
The results of the study suggest that the high prevalence of carbapenem resistance among Acinetobacter organisms in this institution is not caused by the spread of a predominant clone and that other factors may need to be investigated.
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