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Title: | A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition |
Author: | Suarez, Cristina Peña Miralles, Carmen Arch, Olga Domínguez Luzón, Ma. Ángeles (María Ángeles) Tubau, Fe Juan, Carlos Gavaldá, Laura Sora, Mercedes Oliver, Antonio Pujol Rojo, Miquel Ariza Cardenal, Javier |
Keywords: | Pseudomonas Epidemiologia Infeccions nosocomials Higiene hospitalària Pseudomonas Epidemiology Nosocomial infections Hospital hygiene |
Issue Date: | 13-Oct-2011 |
Publisher: | BioMed Central |
Abstract: | Background: Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied. Methods: Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented. Results: Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more. Conclusions: In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem. |
Note: | Reproducció del document publicat a: https://doi.org/10.1186/1471-2334-11-272 |
It is part of: | Bmc Infectious Diseases, 2011, vol. 11, p. 272 |
URI: | http://hdl.handle.net/2445/119284 |
Related resource: | https://doi.org/10.1186/1471-2334-11-272 |
ISSN: | 1471-2334 |
Appears in Collections: | Articles publicats en revistes (Institut d'lnvestigació Biomèdica de Bellvitge (IDIBELL)) Articles publicats en revistes (Ciències Clíniques) Articles publicats en revistes (Patologia i Terapèutica Experimental) |
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