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Identification and Control of Carbapenem-Resistant Klebsiella pneumoniae (KPC) in a Community Hospital
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American Journal of Infection Control June 2009
converting it into the population ratio. In the amount of vancomycin use, in Japan, the detection frequency of VISA and hetero-VISA might not increase.In 1990s, VISA and hetero-VISA were reported in Japanese hospital patients. These VISA and hetero-VISA may relate some different factors. For instance, it might be one of factors that carbapenem antibiotics had been widely used to treat MRSA before intravenous vancomycin was approved in 1991 in Japan.
Presentation Number: 1-6
Identification and Control of Carbapenem-Resistant Klebsiella pneumoniae (KPC) in a Community Hospital Tammy Irving, RN CIC, Infection Control Manager, Chesapeake Regional Medical Center, Chesapeake, VA Issue: Carbapenem resistant K. pneumoniae were first reported in 1999 and have now been reported in 24 states. In November 2007 our microbiology laboratory identified isolates with suspected carapenem resistance. Because these organisms were not known to be present in our geographic region 5 isolates were sent to the CDC and confirmed to be KPC. Project: A case definition was developed and a case finding look back noted the first presumptive case in Feb 07. Based on CDC recommendations the microbiology laboratory began conducting the modified Hodge Test on all K. pneumoniae isolates with imipenem MIC $ 1mg/L. This was followed by a rapid increase in cases. The following control measures were implemented: Nursing leaders and hospital administrators were educated and regularly updated. Patients with KPC were placed in Contact Isolation and cohorted on a single nursing unit. Mandatory staff education was conducted. Patient and physician education materials were provided. Medical records were flagged to ensure immediate isolation on readmission. Environmental cleaning was emphasized with checklists provided to staff and cleaning frequency increased. Daily KPC census alerts were sent to hospital managers to encourage continued vigilance. A business plan was developed and an active surveillance screening program was implemented to screen hospital admissions from long term care facilities. Results: Between Jan 08 - Apr 08, 58 patients with KPC infection or colonization were identified. The mean age was 70.1 years. 36% of the patients were from long term care facilities. The majority of the organisms were isolated from urine or sputum. 75% of the organisms were acquired in the healthcare setting. The crude mortality rate was 22%. Despite intensive control measures KPC acquisition continues to occur. Lessons Learned: Carbapenem resistant K. pneumoniae is an emerging healthcare associated pathogen associated with high morbidity and mortality. There are limited treatment options available thus improved detection methods and effective prevention methods are critical. Because KPCs had not previously been known to exist in the region, information and resources were shared with area ICPs and health department representatives. Increased awareness is needed in the infection control community to recognize and address this emerging pathogen.
Presentation Number: 1-7
Increasing In vitro Resistance to Moxifloxacin and Gatifloxacin Among S. epidermidis Isolates Recovered from Patients with Endophthalmitis Following Cataract Surger Darlene Miller, DHSC, MPH, SM, CIC, Assistant Research Professor; Eduardo C. Alfonso, MD, Professor, Bascom Palmer Eye Inst, Miami, FL Issue: Increasing resistance to fluoroquinolones among Staphylococcus epidermidis isolates recovered from patients with Endophthalmitis have important implications for the prevention and treatment of these post surgical infections and the preservation of vision. Project: More than 4 million cases of cataract surgery were performed in the United States in 2004. Post surgical infection rates are uncommon (1/1000 cases) but can result in compromised or permanent loss of vision.
American Journal of Infection Control June 2009
converting it into the population ratio. In the amount of vancomycin use, in Japan, the detection frequency of VISA and hetero-VISA might not increase.In 1990s, VISA and hetero-VISA were reported in Japanese hospital patients. These VISA and hetero-VISA may relate some different factors. For instance, it might be one of factors that carbapenem antibiotics had been widely used to treat MRSA before intravenous vancomycin was approved in 1991 in Japan.
Presentation Number: 1-6
Identification and Control of Carbapenem-Resistant Klebsiella pneumoniae (KPC) in a Community Hospital Tammy Irving, RN CIC, Infection Control Manager, Chesapeake Regional Medical Center, Chesapeake, VA Issue: Carbapenem resistant K. pneumoniae were first reported in 1999 and have now been reported in 24 states. In November 2007 our microbiology laboratory identified isolates with suspected carapenem resistance. Because these organisms were not known to be present in our geographic region 5 isolates were sent to the CDC and confirmed to be KPC. Project: A case definition was developed and a case finding look back noted the first presumptive case in Feb 07. Based on CDC recommendations the microbiology laboratory began conducting the modified Hodge Test on all K. pneumoniae isolates with imipenem MIC $ 1mg/L. This was followed by a rapid increase in cases. The following control measures were implemented: Nursing leaders and hospital administrators were educated and regularly updated. Patients with KPC were placed in Contact Isolation and cohorted on a single nursing unit. Mandatory staff education was conducted. Patient and physician education materials were provided. Medical records were flagged to ensure immediate isolation on readmission. Environmental cleaning was emphasized with checklists provided to staff and cleaning frequency increased. Daily KPC census alerts were sent to hospital managers to encourage continued vigilance. A business plan was developed and an active surveillance screening program was implemented to screen hospital admissions from long term care facilities. Results: Between Jan 08 - Apr 08, 58 patients with KPC infection or colonization were identified. The mean age was 70.1 years. 36% of the patients were from long term care facilities. The majority of the organisms were isolated from urine or sputum. 75% of the organisms were acquired in the healthcare setting. The crude mortality rate was 22%. Despite intensive control measures KPC acquisition continues to occur. Lessons Learned: Carbapenem resistant K. pneumoniae is an emerging healthcare associated pathogen associated with high morbidity and mortality. There are limited treatment options available thus improved detection methods and effective prevention methods are critical. Because KPCs had not previously been known to exist in the region, information and resources were shared with area ICPs and health department representatives. Increased awareness is needed in the infection control community to recognize and address this emerging pathogen.
Presentation Number: 1-7
Increasing In vitro Resistance to Moxifloxacin and Gatifloxacin Among S. epidermidis Isolates Recovered from Patients with Endophthalmitis Following Cataract Surger Darlene Miller, DHSC, MPH, SM, CIC, Assistant Research Professor; Eduardo C. Alfonso, MD, Professor, Bascom Palmer Eye Inst, Miami, FL Issue: Increasing resistance to fluoroquinolones among Staphylococcus epidermidis isolates recovered from patients with Endophthalmitis have important implications for the prevention and treatment of these post surgical infections and the preservation of vision. Project: More than 4 million cases of cataract surgery were performed in the United States in 2004. Post surgical infection rates are uncommon (1/1000 cases) but can result in compromised or permanent loss of vision.