华西医学

华西医学

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Carbapenemase producing Enterobacteriaceae (CPE) has emerged as a significant global public health challenge and placing infected patients at risk of potentially untreatable infections. When resistance to carbapenems occurs, there are often few alternative treatments available. Numerous international guidelines have performed systematic and evidence review to identify new strategies to prevent the entry and spread of CPE in healthcare settings. Several key strategies have been shown to be highly effective. Firstly a new strategy that is proven to be effective is the early identification of the CPE carrier patients through active surveillance cultures. While waiting for the screening results, suspected CPE carriers will be put on preemptive isolation in single room and healthcare worker will at the same time practice contact precautions. The active surveillance culture and prompt preemptive isolation will limit the entry and spread of CPE from getting into hospital. Secondly, it is of utmost importance to incorporate enforcement of the basic infection prevention and control best practices in the hospital including, full compliance to hand hygiene, appropriate use of personal protective equipment, execute antibiotic stewardship program to control abuse of antibiotics, effective environmental cleaning and decontamination, staff education and feedback, as well as surveillance of healthcare-associated infections. Such a holistic approach has been shown to be effective in inhibiting CPE from gaining foothold in the hospital.

Key words: Carbapenemase producing Enterobacteriaceae; Infection prevention and control; Early identification; Preemptive isolation

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1. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities. Licence: CC BY-NC-SA 3.0 IGO. Geneva: World Health Organization, 2017.
2. Magiorakos AP, Burns K, Rodríguez Baño J, et al. Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control. Antimicrob Resist Infect Control, 2017, 6: 113.
3. Public Health England. Acute trust toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae. London: Public Health England, 2013. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/329227/Acute_trust_toolkit_for_the_early_detection.pdf.
4. Health Protection Scotland. Toolkit for the early detection, management and control of carbapenemase-producing Enterobacteriaceae in Scottish acute settings. (2018-11-20)[2019-01-01]. https://www.hps.scot.nhs.uk/haiic/amr/resourcedetail.aspx?id=478.
5. Centers for Disease Control and Prevention Facility guidance for control of carbapenem resistant Enterobacteriaceae (CRE): November 2015 update - CRE toolkit 2015. Atlanta: Centers for Disease Control and Prevention, 2015. https://www.cdc.gov/hai/pdfs/cre/CRE-guidance-508.pdf.
6. Public Health Agency of Canada. Carbapenem resistant gram-negative bacilli, 2010. (2012-01-26)[2019-01-01]. https://www.health.gov.nl.ca/health/publichealth/cdc/infectioncontrol/carbapenem_resistant_patient.pdf.
7. Australian Commission on Safety and Quality in Health Care. Recommendations for the control of multi-drug resistant Gram-negatives: carbapenem resistant Enterobacteriaceae (October 2013). Sydney: ACSQHC, 2013.
8. French CE, Coope C, Conway L, et al. Control of carbapenemase-producing Enterobacteriaceae outbreaks in acute settings: an evidence review. J Hosp Infect, 2017, 95(1): 3-45.
9. Otter JA, Burgess P, Davies F, et al. Counting the cost of an outbreak of carbapenemase-producing Enterobacteriaceae: an economic evaluation from a hospital perspective. Clin Microbiol Infect, 2017, 23(3): 188-196.
10. Feldman N, Adler A, Molshatzki N, et al. Gastrointestinal colonization by KPC-producing Klebsiella pneumoniae following hospital discharge: duration of carriage and risk factors for persistent carriage. Clin Microbiol Infect, 2013, 19(4): E190-E196.
11. Zimmerman FS, Assous MV, Bdolah-Abram T, et al. Duration of carriage of carbapenem-resistant Enterobacteriaceae following hospital discharge. Am J Infect Control, 2013, 41(3): 190-194.
12. Schwartz-Neiderman A, Braun T, Fallach N, et al. Risk Factors for carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) acquisition among contacts of newly diagnosed CP-CRE Patients. Infect Control Hosp Epidemiol, 2016, 37(10): 1219-1225.
13. European Committee on Antimicrobial Susceptibility Testing. EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance EUCAST, Växjö. 2013. http://www.eucast.org/fileadmin/src/media/PDFs/EUCAST_files/Resistance_mechanisv1.0_20131211.pdf.
14. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; twenty-second informational supplement. Wayne, PA: CLSI2012.