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Hospital outbreak control requires joint efforts from hospital management, microbiology and infection control
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology. (Åsa Melhus)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Bacteriology.
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2010 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 76, no 1, 26-31 p.Article in journal (Refereed) Published
Abstract [en]

An outbreak of multidrug-resistant Klebsiella pneumoniae producing the extended-spectrum beta-lactamase CTX-M-15 affected 247 mainly elderly patients in more than 30 wards in a 1000-bedded Swedish teaching hospital between May 2005 and August 2007. A manual search of the hospital administrative records for possible contacts between cases in wards and outpatient settings revealed a complex chain of transmission. Faecal screening identified twice as many cases as cultures from clinical samples. Transmission occurred by direct and indirect patient-to-patient contact, facilitated by patient overcrowding. Interventions included formation of a steering group with economic power, increased bed numbers, better compliance with alcohol hand disinfection and hospital dress code, better hand hygiene for patients and improved cleaning. The cost of the interventions was estimated to be €3 million. Special infection control policies were not necessary, but resources were needed to make existing policies possible to follow, and for educational efforts to improve compliance.

Place, publisher, year, edition, pages
Amsterdam: Elsevier , 2010. Vol. 76, no 1, 26-31 p.
Keyword [en]
Infection control, klebsiella pneumoniae, extended spectrum beta-lactamase, ESBL, CTX-M 15, hand hygiene, screening, outbreak, overcrowding, understaffning
Keyword [sv]
vårdhygien, utbrott, handhygien, överbeläggning, underbemanning
National Category
Medical and Health Sciences
Research subject
Clinical Bacteriology
Identifiers
URN: urn:nbn:se:uu:diva-131895DOI: 10.1016/j.jhin.2010.01.018ISI: 000281403700005PubMedID: 20359768OAI: oai:DiVA.org:uu-131895DiVA: diva2:356004
Available from: 2010-10-09 Created: 2010-10-09 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases: Aspects of Detection, Epidemiology and Control
Open this publication in new window or tab >>Enterobacteriaceae Producing Extended-Spectrum Beta-Lactamases: Aspects of Detection, Epidemiology and Control
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Enterobacteriaceae belong to the normal enteric flora in humans and may cause infections. Escherichia coli is the leading urinary tract pathogen with septicaemic potential, whereas Klebsiella pneumoniae causes opportunistic infections and often outbreaks in hospital settings. Beta-lactams are the first choice for treatment of infections caused by Enterobacteriaceae, and might be destroyed by extended-spectrum beta-lactamases, ESBLs. ESBLs hydrolyse all beta-lactams except cephamycin and carbapenems, and constitute a large heterogeneous group of enzymes with different origins. The phenotypic and molecular characteristics of a K. pneumoniae strain causing a major outbreak at Uppsala University Hospital between 2005 and 2008 were described. The strain was multiresistant and produced CTM-M-15, a common ESBL type in Europe. Due to the lack of obvious epidemiological links between patients, a case-control study was performed, which identified risk factors for the acquisition of the outbreak strain in urine cultures. The complex chain of transmission facilitated by patient overcrowding and the interventions applied to curb the outbreak, was revealed in the subsequent study. In the final study, the genetic background of the observed increase in ESBL-producing E. coli isolates during the K. pneumoniae outbreak was explored. The utility of six typing methods in epidemiological investigations of a local outbreak with ESBL-producing E. coli was compared. The increase of ESBL-producing E. coli isolates was not secondary to the K. pneumoniae outbreak. Twentytwo per cent belonged to the epidemic O25b-ST131 clone and only a limited number of infections were caused by nosocomial transmission. ESBL-producing Enterobacteriaceae are a challenge to clinical microbiology laboratories and infection control teams. To investigate their dissemination, typing methods need to be continuously adapted to the current situation. Proper hand disinfection and structural key problems such as over-crowding, under-staffing, lack of single rooms and bathrooms must be adressed to limit transmission.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 57 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 610
Keyword
Extended-spectrum beta-lactamase, ESBL, pulse-field gel elctrophoresis, typing methods, infection control, typningsmetoder, vårdhygien
National Category
Microbiology in the medical area
Research subject
Clinical Bacteriology
Identifiers
urn:nbn:se:uu:diva-131901 (URN)978-91-554-7922-0 (ISBN)
Public defence
2010-12-03, Hörsalen, Klinisk mikrobiologi, Dag Hammarskölds väg 17, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-11-12 Created: 2010-10-09 Last updated: 2018-01-12Bibliographically approved

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