- Email: [email protected]
Effectiveness of a multidisciplinary antimicrobial stewardship program in reducing the rate of carbapenem-resistant Acinetobacter baumannii in a university hospital of Taiwan
Abstracts of the 7th International Congress of the Asia Pacific Society of Infection Control, Taipei, Taiwan, March 26-29, 2015
PS 1-170 EFFECTIVENESS OF A MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP PROGRAM IN REDUCING THE RATE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN A UNIVERSITY HOSPITAL OF TAIWAN Ti-Ying Hsu a,c, Hsin-Pai Chen b,c, Hui-Chun Yu c,d, Yu-Ching Lin c,d, YuehChun Weng c,e, Yuan-Ming Lee c,e, Chia-Wei Lin c,f, Jen-Jen Tang c,f, YaPing Li c,g, Wei-Shu Wang h, Su-Shun Lo c,i. aInfection Control Office, National Yang-Ming University Hospital, Yilan, Taiwan; bDepartment of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; cSchool of Medicine, National Yang-Ming University, Taipei, Taiwan; dInfection Control Office, National Yang-Ming University Hospital, Yilan, Taiwan; eDepartment of Laboratory Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; fDepartment of Pharmacy, National Yang-Ming University Hospital, Yilan, Taiwan; gDepartment of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan; hDepartment of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; iDepartment of Surgery, National YangMing University Hospital, Yilan, Taiwan Purpose: Infection by drug-resistant bacteria complicates patient treatment, threatens patient safety, and increases medical expanses. Among the drug-resistant bacteria, carbapenem-resistant Acinetobacter baumannii (CRAB) has been increasingly recognized in hospitals of Taiwan. A growing body of evidence suggests that implementation of antimicrobial stewardship programs (ASPs) is effective in reducing both inappropriate antimicrobial use and, subsequently, the rate of drug-resistant bacteria. In a university hospital in northeastern Taiwan, a multidisciplinary ASP was implemented with the aim of reducing the consumption of carbapenems and the rate of CRAB. Methods: The ASP includes several components. First, a computerized hospital-wide surveillance system was established to facilitate infection control measures of drug-resistant bacteria. Using a computerized antimicrobial approval system, the appropriateness of carbapenem prescription was reviewed by the infectious disease physician. In units with high prevalence, active surveillance screening culture for CRAB was done upon admission. Finally, a quality-improvement activity was introduced to improve the quality of environmental cleaning in the hospital. Results: The rate of CRAB reached its highest in January 2014, exceeding 70.83%. After implementation of the ASP, there was a gradual and steady decrease in the rate of CRAB, falling below 30% in July 2014. Compared with its highest, the rate of CRAB decreased 41.2% within 6 months of the ASP.(Figure one)
Figure 1 Trend of carbapenem-resistant Acinetobacter baumannii after implementation of the antimicrobial stewardship program. Conclusions: A coordinated multidisciplinary ASP is effective in reducing the rate of CRAB in the hospital. The effect is obvious since the early phase of intervention.
PS 1-171 EMERGENCE OF OXA-48 CARBAPENEMASE IN TAIWAN Ling Ma a, Peijing Chen a, Fumei Lin a, Yijiun Ding a, Liyue Huang a, Jenchang Chang a, Qihong Liu a, Yukuo Tai a, Poliang Lu b. aNational Institute of Infectious Diseases and Vaccionology, Nationl Health Research Institutes, Zhunan, Taiwan; bDepartment of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Purpose: OXA-48 producing Enterbacteriaceae are increased dramatically in Mediterranean countries in the past ten years. It has been found in Asia
S107
recently. Here, we report the emergence of OXA-48 during a nationwide survey in Taiwan. Methods: A 4 year carbapenem resistant Enterobacteriaceae surveillance program was conducted from 2012. From 2012 to May 2014, we obatained 760 carbapenem non-susceptible K. pneumoniae (CnSKP) and 144 carbapenem non-susceptible E.coli (CnSEC) isolates till April 2014. Antibiotics susceptibility test, detection of carbapenemase, ESBLs and AmpC, outer membrane porin (omp) profiles and genetic relationship with PFGE and MLST were performed. Results: Four OXA-48 producing K.pneumoniae were detected after 28 month screening. The OXA-48 gene is encoded by a conjugative plasmid and associated with IS1999. The upstream of blaOXA-48 identical to pKoxa48N1, four plasmids showed similar digestion profiles, the plasmid size was predicted over 62Kb. Three isolates co-produced CTX-M enzyme and belong to ST11, their plasmid belong to Inc A/C. Four isolates belong to three different clones. Conclusions: It is the second report of OXA-48 on IncA/C plasmid in K.pneumoniae. The association OXA-48 and CTX-M lead to pan-resistance. Taking into account the pandemic clone of ST11 K.pneumoniae and incorporation of Inc A/C plasmid, the rapid dissemination of ST11 OXA-48 combined with CTX-M ESBL is of great concern.
PS 1-172 INCREASING HAND HYGIENE COMPLIANCE TO REDUCE THE INCIDENCE OF MULTIDRUG RESISTANT ACINETOBACTER BAUMANII IN VENTILATOR ASSOCIATED PNEUMONIA IN ICU SILOAM HOSPITALS SURABAYA Bambang Wahjoeprajitno a, Agung Dwi Wahyu Widodo b, Bernadetta Indah Mustikawati c, Niken Syitharini d, Sri Widyaningtyastuti e. a Anesthestis Faculty of Medicine e University of Airlangga; bMicrobiologist Faculty of Medicine e University of Airlangga; cQuality and Risk Siloam Hospitals Surabaya; dInfection Control Nurse, Siloam Hospitals Surabaya; e Infection Control Nurse, Siloam Hospitals Surabaya Purpose: To reduce the incidence of multi drug resistance acinetobacter baumanii (MDRAB) in ventilator associated pneumonia (VAP) from 12.82 to 2 per 1000 device days by increasing hand hygiene compliance among staff and doctors in ICU. Methods: We implement multi strategy to reduse MDRAB in VAP using APIC guideline. One of the strategy is improving hand hygiene compliance. Strategy to improving hand hygiene compliance in ICU are : install alcohol based handrub in every bed, poster reminder in ICU facility, warning system by install CCTV, conduct hand hygiene compliance audit every month by direct monitoring and give immediate feedback to staff and doctor based on CCTV record, report about quality improvement to CEO and hospital administration, reward and punishment based on hand hygiene compliance every staf in Key Performance Indicator Portfolio. Result: Hand hygiene compliance in ICU in 2012 was 61.47%, increase to 94.3 % in 2014 Incidence of MDRAB in VAP in 2012 was 12.82 per 1000 vetilatordays, decrease to 0 in 2014. Conclusions: Increasing of hand hygiene compliance can reduce the incidence of multi drug resistance acinetobacter baumanii (MDRAB) in ventilator associated pneumonia (VAP) in ICU Siloam Hospitals Surabaya
PS 1-170 EFFECTIVENESS OF A MULTIDISCIPLINARY ANTIMICROBIAL STEWARDSHIP PROGRAM IN REDUCING THE RATE OF CARBAPENEM-RESISTANT ACINETOBACTER BAUMANNII IN A UNIVERSITY HOSPITAL OF TAIWAN Ti-Ying Hsu a,c, Hsin-Pai Chen b,c, Hui-Chun Yu c,d, Yu-Ching Lin c,d, YuehChun Weng c,e, Yuan-Ming Lee c,e, Chia-Wei Lin c,f, Jen-Jen Tang c,f, YaPing Li c,g, Wei-Shu Wang h, Su-Shun Lo c,i. aInfection Control Office, National Yang-Ming University Hospital, Yilan, Taiwan; bDepartment of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; cSchool of Medicine, National Yang-Ming University, Taipei, Taiwan; dInfection Control Office, National Yang-Ming University Hospital, Yilan, Taiwan; eDepartment of Laboratory Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; fDepartment of Pharmacy, National Yang-Ming University Hospital, Yilan, Taiwan; gDepartment of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan; hDepartment of Medicine, National Yang-Ming University Hospital, Yilan, Taiwan; iDepartment of Surgery, National YangMing University Hospital, Yilan, Taiwan Purpose: Infection by drug-resistant bacteria complicates patient treatment, threatens patient safety, and increases medical expanses. Among the drug-resistant bacteria, carbapenem-resistant Acinetobacter baumannii (CRAB) has been increasingly recognized in hospitals of Taiwan. A growing body of evidence suggests that implementation of antimicrobial stewardship programs (ASPs) is effective in reducing both inappropriate antimicrobial use and, subsequently, the rate of drug-resistant bacteria. In a university hospital in northeastern Taiwan, a multidisciplinary ASP was implemented with the aim of reducing the consumption of carbapenems and the rate of CRAB. Methods: The ASP includes several components. First, a computerized hospital-wide surveillance system was established to facilitate infection control measures of drug-resistant bacteria. Using a computerized antimicrobial approval system, the appropriateness of carbapenem prescription was reviewed by the infectious disease physician. In units with high prevalence, active surveillance screening culture for CRAB was done upon admission. Finally, a quality-improvement activity was introduced to improve the quality of environmental cleaning in the hospital. Results: The rate of CRAB reached its highest in January 2014, exceeding 70.83%. After implementation of the ASP, there was a gradual and steady decrease in the rate of CRAB, falling below 30% in July 2014. Compared with its highest, the rate of CRAB decreased 41.2% within 6 months of the ASP.(Figure one)
Figure 1 Trend of carbapenem-resistant Acinetobacter baumannii after implementation of the antimicrobial stewardship program. Conclusions: A coordinated multidisciplinary ASP is effective in reducing the rate of CRAB in the hospital. The effect is obvious since the early phase of intervention.
PS 1-171 EMERGENCE OF OXA-48 CARBAPENEMASE IN TAIWAN Ling Ma a, Peijing Chen a, Fumei Lin a, Yijiun Ding a, Liyue Huang a, Jenchang Chang a, Qihong Liu a, Yukuo Tai a, Poliang Lu b. aNational Institute of Infectious Diseases and Vaccionology, Nationl Health Research Institutes, Zhunan, Taiwan; bDepartment of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan Purpose: OXA-48 producing Enterbacteriaceae are increased dramatically in Mediterranean countries in the past ten years. It has been found in Asia
S107
recently. Here, we report the emergence of OXA-48 during a nationwide survey in Taiwan. Methods: A 4 year carbapenem resistant Enterobacteriaceae surveillance program was conducted from 2012. From 2012 to May 2014, we obatained 760 carbapenem non-susceptible K. pneumoniae (CnSKP) and 144 carbapenem non-susceptible E.coli (CnSEC) isolates till April 2014. Antibiotics susceptibility test, detection of carbapenemase, ESBLs and AmpC, outer membrane porin (omp) profiles and genetic relationship with PFGE and MLST were performed. Results: Four OXA-48 producing K.pneumoniae were detected after 28 month screening. The OXA-48 gene is encoded by a conjugative plasmid and associated with IS1999. The upstream of blaOXA-48 identical to pKoxa48N1, four plasmids showed similar digestion profiles, the plasmid size was predicted over 62Kb. Three isolates co-produced CTX-M enzyme and belong to ST11, their plasmid belong to Inc A/C. Four isolates belong to three different clones. Conclusions: It is the second report of OXA-48 on IncA/C plasmid in K.pneumoniae. The association OXA-48 and CTX-M lead to pan-resistance. Taking into account the pandemic clone of ST11 K.pneumoniae and incorporation of Inc A/C plasmid, the rapid dissemination of ST11 OXA-48 combined with CTX-M ESBL is of great concern.
PS 1-172 INCREASING HAND HYGIENE COMPLIANCE TO REDUCE THE INCIDENCE OF MULTIDRUG RESISTANT ACINETOBACTER BAUMANII IN VENTILATOR ASSOCIATED PNEUMONIA IN ICU SILOAM HOSPITALS SURABAYA Bambang Wahjoeprajitno a, Agung Dwi Wahyu Widodo b, Bernadetta Indah Mustikawati c, Niken Syitharini d, Sri Widyaningtyastuti e. a Anesthestis Faculty of Medicine e University of Airlangga; bMicrobiologist Faculty of Medicine e University of Airlangga; cQuality and Risk Siloam Hospitals Surabaya; dInfection Control Nurse, Siloam Hospitals Surabaya; e Infection Control Nurse, Siloam Hospitals Surabaya Purpose: To reduce the incidence of multi drug resistance acinetobacter baumanii (MDRAB) in ventilator associated pneumonia (VAP) from 12.82 to 2 per 1000 device days by increasing hand hygiene compliance among staff and doctors in ICU. Methods: We implement multi strategy to reduse MDRAB in VAP using APIC guideline. One of the strategy is improving hand hygiene compliance. Strategy to improving hand hygiene compliance in ICU are : install alcohol based handrub in every bed, poster reminder in ICU facility, warning system by install CCTV, conduct hand hygiene compliance audit every month by direct monitoring and give immediate feedback to staff and doctor based on CCTV record, report about quality improvement to CEO and hospital administration, reward and punishment based on hand hygiene compliance every staf in Key Performance Indicator Portfolio. Result: Hand hygiene compliance in ICU in 2012 was 61.47%, increase to 94.3 % in 2014 Incidence of MDRAB in VAP in 2012 was 12.82 per 1000 vetilatordays, decrease to 0 in 2014. Conclusions: Increasing of hand hygiene compliance can reduce the incidence of multi drug resistance acinetobacter baumanii (MDRAB) in ventilator associated pneumonia (VAP) in ICU Siloam Hospitals Surabaya