Infection Control & Hospital Epidemiology (2019), 40,368–371 doi:10.1017/ice.2018.344
Concise Communication
The burden of colonization and infection by carbapenemase- producing Enterobacteriaceae in the neuro-rehabilitation setting: a prospective six-year experience
Sara Tedeschi MD1 , Filippo Trapani MD1, Annalisa Liverani ICN2, Fabio Tumietto MD1, Francesco Cristini MD1, Salvatore Pignanelli MD3, Andrea Berlingeri MD4, Jacopo Bonavita MD2, Gian Piero Belloni MD2, Michele Bartoletti MD,
PhD1, Maddalena Giannella MD, PhD1, Roberto Pederzini MD2 and Pierluigi Viale MD1 1Infectious Diseases Unit, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy, 2Montecatone Rehabilitation Institute, Imola, Italy, 3Laboratory Analysis of Clinical Chemistry and Microbiology, S. Maria della Scaletta Hospital, Imola, Italy and 4Microbiology, Teaching Hospital S. Orsola-Malpighi, Alma Mater Studiorum University of Bologna, Bologna, Italy
Abstract
We describe the high burden of carbapenemase-producing Enterobacteriaceae (CPE) colonization and infection in a neuro-rehabilitation hospital in Italy over a 6-year period. Overall, 9.3% of patients were found to be CPE carriers on admission; the rates of CPE in-hospital acquisition and CPE-BSI were 9.2 and 2.9 cases per 10,000 patient days, respectively.
(Received 23 September 2018; accepted 27 November 2018)
Long-term acute-care hospitals (LTACHs) and other post-acute care facilities have been shown to be a major contributor to the dissemination of carbapenemase-producing Enterobacteriaceae (CPE).1 In this context, patients with spinal cord injuries (SCIs) and acquired brain injuries (ABIs) in neuro-rehabilitation units are at increased risk because they usually have experienced a pro- longed stay in an acute-care hospital, they have been exposed to antimicrobials, and they have had invasive medical devices placed. PreventingCPEcross transmissionmay be extremely difficult in this population because caregivers and several healthcare workers with different cultural backgrounds are involved in the patient care, and the usual interventions (eg, strict infection controlmeasures and iso- lation) could reduce patients’ access to rehabilitation activities, ham- pering rehabilitation programs and adversely affecting outcomes.2 To date, epidemiology ofCPEin the neuro-rehabilitation setting
is largely unknown. The aim of this study was to assess the burden ofCPE colonization and infection in a neuro-rehabilitation hospital in Italy and to describe a tailored infection control program.
Materials and methods Study design and setting
We performed a prospective, observational study from January 2012 to December 2017 on all patients admitted to Montecatone
Author for correspondence: Sara Tedeschi, Email:
sara.tedeschi@aosp.bo.it PREVIOUS PRESENTATION: The data reported in this article were presented in part
as an oral presentation during the 27th European Congress of Clinical Microbiology and Infectious Diseases, April 24 2017, in Vienna, Austria. Cite this article: Tedeschi S, et al. (2019). The burden of colonization and infection by
carbapenemase-producing Enterobacteriaceae in the neuro-rehabilitation setting: a prospective six-year experience. Infection Control & Hospital Epidemiology, 40: 368–371,
https://doi.org/10.1017/ice.2018.344
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
Rehabilitation Institute (MRI). MRI is a 150-bed rehabilitation hospital in Northern Italy with ~700 admissions per year; it is dedi- cated to the intensive rehabilitation of patients with SCI and ABI. The hospital has an 8-bed intensive care unit, an 11-bed respiratory intensive care unit, a 23-bed ward dedicated to patients with ABI, a 108-bed spinal unit, a rehabilitation day hospital, and an outpatient clinic.
Since 2012, the management of the infectious risk has been
committed to an infectious disease consultant, who is on site 3 times per week, performs bedside patient evaluations, and coor- dinates a persuasive antimicrobial stewardship program and the infection control activities, as described elsewhere.3
Infection control measures to contain the spread of CPE
The implementation of a tailored infection control program started in 2012. Considering that patients admitted to MRI come from other hospitals and/or have had frequent readmissions, surveil- lance culture (SC) for ruling out CPE colonization are performed on admission in all patients. Contact precaution are maintained until SC result; if the SC is negative, contact precautions are removed and the test is repeated every 2 weeks. Surveillance culture consists of only rectal swab; however, patients with CPE positive cultures from clinical specimens are considered carriers also if the rectal swab is negative. For those patients who are found to be CPE carriers, contact
isolation and geographic separation in a ward cohort are applied; environmental cleaning is performed thrice daily, including bath- room and areas close to the patient (eg, bed rails and bedside table) using chlorhexidine solution. Also, when CPE carriers attend reha- bilitation activities into the gyms in dedicated areas and after the other patients, all the surfaces are cleaned with chlorhexidine
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