1618. Proactive infection control measures to prevent nosocomial transmission of carbapenem-resistant Enterobacteriaceae in a non-endemic area
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Poster_Number 506_Session 63_B1_v2.jpg (896.2 kB)
  • Background: Identification of hospitalized carbapenem-resistant Enterobacteriaceae (CRE)-positive patient is important in preventing nosocomial transmission. The objective of this study is to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between 1 October 2010 and 31 December 2011.

    Methods: The program included active surveillance culture in patients with history of medical tourism and surgical operation outside Hong Kong within 12 months before admission, and "added test” as an opportunistic CRE screening in all fecal specimens submitted to the laboratory. Outbreak investigation and contact tracing were conducted for CRE-positive patients. Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.

    Results: During the study period, a total of 6533 patients were screened for CRE, of which 76 patients were positive (10 from active surveillance culture, 65 from “added test”, and 1 secondary case from contact tracing of 233 patients with no nosocomial outbreak), resulting in an overall rate of CRE fecal carriage of 1.2%. The median time of fecal carriage of CRE was 43 days (range, 13-119 days). Beta-lactam-beta-lactamase-inhibitors, cephalosporins, and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection, while use of cephalosporins, carbapenems, and fluoroquinolones after CRE detection are significantly associated with longer duration of carriage. The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load (Pearson correlation, 0.53; p value, 0.02).

    Conclusion: Proactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.

    Vincent CC Cheng, MBBS, MD, FRCPath1,2, Jasper FW Chan, MBBS, FRCPath2, Sally CY Wong, MBBS, MRCP3, Josepha WM Tai, MHSc(N)1,2, Kelvin K. W. To, MBBS FRCPath2 and Kwok-Yung Yuen, MD2, (1)Infection Control Unit, Queen Mary Hospital, Hong Kong, Hong Kong, (2)Carol Yu Centre for Infection, The University of Hong Kong, Hong Kong, Hong Kong, (3)Microbiology, The University of Hong Kong, Hong Kong, Hong Kong


    V. C. Cheng, None

    J. F. Chan, None

    S. C. Wong, None

    J. W. Tai, None

    K. K. W. To, None

    K. Y. Yuen, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.