Antimicrobial Stewardship Program, COVID-19, and Infection Control: Spread of Carbapenem-Resistant Klebsiella Pneumoniae Colonization in ICU COVID-19 Patients. What Did Not Work?
Tiri Beatrice,Sensi Emanuela,Marsiliani Viola,Cantarini Mizar,Priante Giulia,Vernelli Carlo,Martella Lucia Assunta,Costantini Monya,Mariottini Alessandro,Andreani Paolo,Bruzzone Paolo,Suadoni Fabio,Francucci Marsilio,Cirocchi Roberto,Cappanera Stefano
Journal of clinical medicine
The Italian burden of disease associated with infections due to antibiotic-resistant bacteria has been very high, largely attributed to (). The implementation of infection control measures and antimicrobial stewardship programs (ASP) has been shown to reduce healthcare-related infections caused by multidrug resistance (MDR) germs. Since 2016, in our teaching hospital of Terni, an ASP has been implemented in an intensive care unit (ICU) setting, with the "daily-ICU round strategy" and particular attention to infection control measures. We performed active surveillance for search patients colonized by (). In March 2020, coronavirus disease 2019 (COVID-19) arrived and the same ICU was reserved only for COVID-19 patients. In our retrospective observational study, we analyzed the bimonthly incidence of colonization patients and the incidence of acquisition in our ICU during the period of January 2019 to June 2020. In consideration of the great attention and training of all staff on infection control measures in the COVID-19 era, we would have expected a clear reduction in acquisition, but this did not happen. In fact, the incidence of acquisition went from 6.7% in 2019 to 50% in March-April 2020. We noted that 67% of patients that had been changed in posture with prone position were colonized by , while only 37% of patients that had not been changed in posture were colonized by . In our opinion, the high intensity of care, the prone position requiring 4-5 healthcare workers (HCWs), equipped with personal protective equipment (PPE) in a high risk area, with extended and prolonged contact with the patient, and the presence of 32 new HCWs from other departments and without work experience in the ICU setting, contributed to the spread of in our ICU, determining an increase in acquisition colonization.
Increased Risk of Acquisition of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) among a Cohort of COVID-19 Patients in a Teaching Hospital in Tuscany, Italy.
Porretta Andrea Davide,Baggiani Angelo,Arzilli Guglielmo,Casigliani Virginia,Mariotti Tommaso,Mariottini Francesco,Scardina Giuditta,Sironi Daniele,Totaro Michele,Barnini Simona,Privitera Gaetano Pierpaolo
Pathogens (Basel, Switzerland)
We describe the epidemiology of New Delhi Metallo-Beta-Lactamase-Producing Carbapenem-Resistant Enterobacterales (NDM-CRE) colonization/infection in a cohort of COVID-19 patients in an Italian teaching hospital. These patients had an increased risk of NDM-CRE acquisition versus the usual patients (75.9 vs. 25.3 cases/10,000 patient days). The co-infection significantly increased the duration of hospital stay (32.9 vs. 15.8 days).