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Bundled intervention reduced KPC infection, colonization
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A bundled intervention resulted in significant reductions in colonization and infection with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae among patients in long-term acute care hospitals, according to researchers for the CDC Epicenters Program.
The rate of K. pneumoniae carbapenemase-producing Enterobactericeae (KPC) bloodstream infections declined by almost 60%, despite a high prevalence of KPC colonization at the beginning of the study.
“These results demonstrate that control is possible despite high colonization pressure and repeated introduction of KPC-positive patients, and should provide support for other health care facilities that are working to lower the burden of KPC in their patient populations,” the researchers wrote in Clinical Infectious Diseases.
Mary K. Hayden, MD, professor of medicine at Rush University Medical Center, and colleagues evaluated KPC colonization and infection rates after implementation of a bundled intervention using a stepped-wedge design in four long-term acute care hospitals in Chicago. In the pre-intervention period, the prevalence of KPC colonization was measured at each facility using semiannual rectal swab culture surveys. During the intervention, patients were screened for KPC rectal colonization at admission and biweekly. Other intervention components included contact isolation and geographic separation KPC-positive patients, daily bathing with 2% chlorhexidine gluconate-impregnated cloths, and health care worker education and monitoring.
In the pre-intervention period, the average rate of KPC rectal colonization was 45.8%. The rate declined early during intervention and reached a plateau of 34.3%. Although the prevalence of KPC colonization at admission remained high during the intervention (20.6%; 95% CI, 19.1%-22.3%), the incidence rate of acquisitions fell four KPC acquisitions to two KPC acquisitions per 100 patient-weeks.
After the intervention, there was a 32% reduction in the rate of KPC isolation from any clinical culture: 3.7 to 2.5 events per 1,000 patient-days. There also was a 56% reduction in KPC bloodstream infections, from 0.9 to 0.4 events per 1,000 patient-days. In addition, there was a 32% decline in bloodstream infections due to any pathogen: 11.2 to 7.6 events per 1,000 patient-days.
“Because the intervention comprised a bundle of infection prevention measures, it is not possible to know with certainty which bundle component(s) were necessary and sufficient for the KPC-specific or broader improvements,” the researchers wrote. “Evaluation of long-term and regional effects of the intervention is warranted.”
Disclosure: Hayden conducted unpaid research for Cepheid Corp.
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