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Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?
Tiri, Beatrice; Sensi, Emanuela; Marsiliani, Viola; Cantarini, Mizar; Priante, Giulia; Vernelli, Carlo; Martella, Lucia Assunta; Costantini, Monya; Mariottini, Alessandro; Andreani, Paolo; Bruzzone, Paolo; Suadoni, Fabio; Francucci, Marsilio; Cirocchi, Roberto; Cappanera, Stefano.
Afiliación
  • Tiri B; Antimicrobial Stewardship Unit, Department of medicine, St. Maria Hospital, 05100 Terni, Italy.
  • Sensi E; Department of Critical Care Medicine and Anesthesiology, St. Maria Hospital, 05100 Terni, Italy.
  • Marsiliani V; Department of Critical Care Medicine and Anesthesiology, St. Maria Hospital, 05100 Terni, Italy.
  • Cantarini M; Department of Critical Care Medicine and Anesthesiology, St. Maria Hospital, 05100 Terni, Italy.
  • Priante G; Infectious Diseases Clinic, Department of medicine, St. Maria Hospital, 05100 Terni, Italy.
  • Vernelli C; Infectious Diseases Clinic, Department of medicine, St. Maria Hospital, 05100 Terni, Italy.
  • Martella LA; Infectious Diseases Clinic, Department of medicine, St. Maria Hospital, 05100 Terni, Italy.
  • Costantini M; Pharmacy Unit, St. Maria Hospital, 05100 Terni, Italy.
  • Mariottini A; Hematology and Microbiology Laboratory, St. Maria Hospital, 05100 Terni, Italy.
  • Andreani P; Hematology and Microbiology Laboratory, St. Maria Hospital, 05100 Terni, Italy.
  • Bruzzone P; Department of General and Specialist Surgery "Paride Stefanini", 00185 Rome, Italy.
  • Suadoni F; Section of Legal Medicine, St. Maria Hospital, 05100 Terni, Italy.
  • Francucci M; Department of General and Oncologic Surgery, St. Maria Hospital, 05100 Terni, Italy.
  • Cirocchi R; Department of General and Oncologic Surgery, University of Perugia, St. Maria Hospital, 05100 Terni, Italy.
  • Cappanera S; Antimicrobial Stewardship Unit, Department of medicine, St. Maria Hospital, 05100 Terni, Italy.
J Clin Med ; 9(9)2020 Aug 25.
Article en En | MEDLINE | ID: mdl-32854334
The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the "daily-ICU round strategy" and particular attention to infection control measures. We performed active surveillance for search patients colonized by Carbapenem-Resistant Enterobacteriaceae (CRE). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of CRE colonization patients and the incidence of CRE acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in CRE acquisition, but this did not happen. In fact, the incidence of CRE acquisition went from 6.7% in 2019 to 50% in March-April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by CRE, while only 37% of patients that had not been changed in posture were colonized by CRE. In our opinion, the high intensity of care, the prone position requiring 4-5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of CR-Kp in our ICU, determining an increase in CRE acquisition colonization.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Observational_studies Idioma: En Revista: J Clin Med Año: 2020 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Suiza

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Observational_studies Idioma: En Revista: J Clin Med Año: 2020 Tipo del documento: Article País de afiliación: Italia Pais de publicación: Suiza