Epidemiology and successful containment of a carbapenem-resistant Enterobacteriaceae outbreak in a Southern Italian Transplant Institute

Transpl Infect Dis. 2019 Aug;21(4):e13119. doi: 10.1111/tid.13119. Epub 2019 Jun 11.

Abstract

Introduction: Carbapenem-resistant enterobacteriaceae (CRE) infections are difficult to treat and pose a serious threat to solid organ transplant (SOT) recipients. At our institute we observed an infection burden in 2012.

Methods: In order to contain the spread of CRE infections, we established a taskforce to implement guidelines suggested by the Centers for Disease Control and Prevention (CDC) for this type of outbreak. Here, we describe the epidemiology of the outbreak in our SOT population, and the effectiveness of such interventions, by comparing levels of CRE hospital-acquired infection (HAI) pre- and post-task force intervention (from January 2009 to December 2012, and from September 2013 to December 2016, respectively) through a linear regression model.

Results: In this study, we included 933 patients who underwent a total of 1017 SOT procedures, 286 of whom had a CRE-positive culture (28.8%), of which 65 (22.7% of CRE positive) developed infection. One-year mortality post-SOT was significantly higher in patients with CRE infection. After the taskforce intervention, the CRE HAI rate in SOT showed a significant inverse trend (event rate: -1.28, CI -1.70 to 0.86; P < 0.01).

Conclusion: In the paucity of treatment options, the application of CDC measures in our SOT institute contributed significantly to containing CRE infections.

Keywords: carbapenem resistant; enterobacteriaceae; infection outbreak; infectious diseases; solid organ transplantation.

Publication types

  • Observational Study

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Antimicrobial Stewardship
  • Carbapenem-Resistant Enterobacteriaceae / drug effects
  • Carbapenems / pharmacology
  • Cross Infection / epidemiology
  • Disease Outbreaks*
  • Enterobacteriaceae Infections / drug therapy
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / mortality
  • Humans
  • Infection Control / methods*
  • Italy / epidemiology
  • Organ Transplantation / adverse effects
  • Regression Analysis
  • Risk Factors
  • Transplant Recipients

Substances

  • Anti-Bacterial Agents
  • Carbapenems