Actively surveillance and appropriate patients placements' contact isolation dramatically decreased Carbapenem-Resistant Enterobacteriaceae infection and colonization in pediatric patients in China

Lijun Yin; Leiyan He; Jin Miao; Weiqing Yang; Xiaohua Wang; Jian Ma; Nana Wu; Yun Cao; Laishuan Wang; Guoping Lu; Liling Li; Chunmei Lu; Jing Hu; Lei Zhang; Bing Zhao; Xiaowen Zhai; Chuanqing Wang

doi:10.1016/j.jhin.2020.03.031

Actively surveillance and appropriate patients placements' contact isolation dramatically decreased Carbapenem-Resistant Enterobacteriaceae infection and colonization in pediatric patients in China

J Hosp Infect. 2020 Mar 31:S0195-6701(20)30130-4. doi: 10.1016/j.jhin.2020.03.031. Online ahead of print.

Authors

Lijun Yin¹, Leiyan He², Jin Miao¹, Weiqing Yang¹, Xiaohua Wang¹, Jian Ma¹, Nana Wu¹, Yun Cao³, Laishuan Wang⁴, Guoping Lu⁵, Liling Li⁶, Chunmei Lu⁴, Jing Hu⁵, Lei Zhang², Bing Zhao⁷, Xiaowen Zhai⁸, Chuanqing Wang⁹

Affiliations

¹ Department of Nosocomial Infection Control, Children's Hospital of Fudan University, Shanghai, China.
² The Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China.
³ Department of neonatal intensive care unit, Children's Hospital of Fudan University, Shanghai, China.
⁴ Department of Neonatal room, Children's Hospital of Fudan University, Shanghai, China.
⁵ Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China.
⁶ Department of Nursing Department, Children's Hospital of Fudan University, Shanghai, China.
⁷ Shanghai Pudong Center for Disease Control and Prevention, Shanghai, China.
⁸ Department of Hematology, Children's Hospital of Fudan University, Shanghai, China. Electronic address: zhaixiaowendy@163.com.
⁹ Department of Nosocomial Infection Control and the Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China. Electronic address: chuanqing523@163.com.

PMID: 32243954
DOI: 10.1016/j.jhin.2020.03.031

Abstract

Background: With the increasing use of carbapenems in clinic practice, carbapenem-resistant Enterobacteriaceae (CRE) has also increased, thus posing a significant threat to human health.

Aim: To assess the effects of CRE colonization active screening and various CRE patient placements implemented in decreasing CRE infection risk.

Methods: CRE colonization screening and various CRE patient placements were performed across CRE high-risk departments (PICU, NICU, neonatal wards and hematology departments) between 2017 and 2018, respectively.

Finding: In 2018, more than 80% neonatal CRE positive patients were isolated using single room or same room isolation, and more than 50% non-neonatal patients were, with no cohort placement. The CRE nosocomial infection incidences decreased from 1.96% to 0.63% in NICU, and from 0.57% to 0.30% in neonatal wards (all P<0.05) while no significant changes were found in the other departments. The CRE colonization incidence at different length hospital stay (LOS) decreased at 8-14days and >14days LOS in CRE high-risk departments (all P<0.05). In addition, 62.5% clinical strains, 66.7% screening strains, and 74.1% nosocomial infection strains were belonged to CC17 complex group in neonatal isolates; while, 56.6%, 47.5% and 100% strains mentioned above were belonged to CC11 complex group in non-neonatal isolates respectively. The predominant carbapenemase gene was bla_NDM-1 (98%) in neonatal and bla_KPC-2 (70%) in non-neonatal CR-KP stains.

Conclusions: Active CRE colonization surveillance and CRE positive patient propriety placement may decrease the CRE infection risk. Neonatal and non-neonatal CR-KP isolates showed different CRE molecular characteristics, which could further benefit CRE infection precaution and antibiotic therapy.

Keywords: Active screening; CC11; CC17; CRE; Carbapenemase genes; Patient’s placement.