Journal of the Korean Medical Association (대한의사협회지)

Korean Medical Association (대한의사협회)
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Management of multi-drug resistant organisms in healthcare settings

의료기관에서의 다제내성균 관리

  • Park, Sun Hee (Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea College of Medicine)
  • 박선희 (가톨릭대학교 의과대학 감염내과)
  • Received : 2017.11.09
  • Accepted : 2017.11.23
  • Published : 2018.01.31
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Abstract

Antimicrobial resistance is an important global threat to public health. Hospitals, in particular, are increasingly faced with the emergence and transmission of multidrug-resistant organisms (MDROs). In hospitals, MDROs are transmitted via the hands of healthcare workers, from the contaminated environment, or directly from person to person. Although the transmission of MDROs is frequently recognized in acute care facilities, all healthcare settings are affected by MDROs. Given the evolving epidemiology of MDROs and the complexity of managing them across heterogeneous healthcare settings, multimodal strategies should be adopted to control and prevent the transmission of MDROs. It is fundamental to ensure adherence to evidence-based healthcare-associated infection prevention strategies, including hand hygiene, antimicrobial stewardship, and adequate environmental cleaning, and to ensure the reliable performance of basic infection prevention practices known to mitigate the transmission of MDROs. Healthcare-associated infections and MDROs should be surveilled in a standardized manner in order to detect outbreaks and newly introduced MDROs in healthcare facilities. When epidemiologically important pathogens newly emerge in healthcare facilities or to control outbreaks of specific pathogens, active surveillance cultures combined with preemptive isolation and contact precautions can also be implemented. Healthcare facilities should make sure that appropriate strategies are fully implemented, regularly evaluated for effectiveness, and adjusted as needed. Successful prevention and control of MDROs can be accomplished by administrative leadership, financial and human resource commitments by individual healthcare facilities, and continuous governmental efforts to make resources available for infection prevention and control.

Keywords

References

  1. World Health Organization. WHO global strategy for containment of antimicrobial resistance [Internet]. Geneva: World Health Organization; 2001 [cited 2017 Dec 15]. Available from: http://www.who.int/drugresistance/WHO_Global_Strategy_English.pdf.
  2. Kim HS, Kim, JI, Park C. Monitoring of antimicrobial resistance on non-tertiary hospitals in Korea, 2007-2014. Public Health Wkly Rep 2015;9:405-408.
  3. Korea Centers for Disease Control and Prevention. Epidemic investigation report for imported CRE outbreak in Korea [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2013 [cited 2017 Dec 15]. Available from: http://cdc.go.kr/CDC/cms/content/mobile/61/21361_view.html.
  4. Jayol A, Poirel L, Dortet L, Nordmann P. National survey of colistin resistance among carbapenemase-producing Enterobacteriaceae and outbreak caused by colistin-resistant OXA-48-producing Klebsiella pneumoniae, France, 2014. Euro Surveill 2016;21.
  5. Jeong SH, Kim HS, Kim JS, Shin DH, Kim HS, Park MJ, Shin S, Hong JS, Lee SS, Song W. Prevalence and molecular characteristics of carbapenemase-producing enterobacteriaceae from five hospitals in Korea. Ann Lab Med 2016; 36:529-535. https://doi.org/10.3343/alm.2016.36.6.529
  6. Siegel JD, Rhinehart E, Jackson M, Chiarello L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10 Suppl 2):S165-S193. https://doi.org/10.1016/j.ajic.2007.10.006
  7. World Health Organization. WHO guidelines on hand hygiene in health care [Internet]. Geneva: World Health Organization; 2009 [cited 2017 Dec 15]. Available from: http://www.who.int/gpsc/5may/tools/9789241597906/en/.
  8. Kim YA, Lee H, Lee K. Contamination of the hospital environmental by pathogenic bacteria and infection control. Korean J Nosocomial Infect Control 2015;20:1-6. https://doi.org/10.14192/kjnic.2015.20.1.1
  9. Dancer SJ. Controlling hospital-acquired infection: focus on the role of the environment and new technologies for decontamination. Clin Microbiol Rev 2014;27:665-690. https://doi.org/10.1128/CMR.00020-14
  10. Teerawattanapong N, Kengkla K, Dilokthornsakul P, Saokaew S, Apisarnthanarak A, Chaiyakunapruk N. Prevention and control of multidrug-resistant gram-negative bacteria in adult intensive care units: a systematic review and network metaanalysis. Clin Infect Dis 2017;64(Suppl 2):S51-S60. https://doi.org/10.1093/cid/cix112
  11. Goodman ER, Platt R, Bass R, Onderdonk AB, Yokoe DS, Huang SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593-599. https://doi.org/10.1086/588566
  12. Kim D, Ahn JY, Lee CH, Jang SJ, Lee H, Yong D, Jeong SH, Lee K. Increasing resistance to extended-spectrum cephalosporins, fluoroquinolone, and carbapenem in gram-negative bacilli and the emergence of carbapenem non-susceptibility in Klebsiella pneumoniae: analysis of Korean Antimicrobial Resistance Monitoring System (KARMS) Data From 2013 to 2015. Ann Lab Med 2017;37:231-239. https://doi.org/10.3343/alm.2017.37.3.231
  13. Choi JY, Kwak YG, Yoo H, Lee SO, Kim HB, Han SH, Choi HJ, Kim HY, Kim SR, Kim TH, Lee H, Chun HK, Kim JS, Eun BW, Kim DW, Koo HS, Cho EH, Lee K; Korean Nosocomial Infections Surveillance System. Trends in the distribution and antimicrobial susceptibility of causative pathogens of device-associated infection in Korean intensive care units from 2006 to 2013: results from the Korean Nosocomial Infections Surveillance System (KONIS). J Hosp Infect 2016;92:363-371. https://doi.org/10.1016/j.jhin.2015.12.012
  14. Hong SK, Yong D, Kim K, Hong SS, Hong SG, Khosbayar T, Song W, Roh KH, Jeong SH, Lee K, Chong Y. First outbreak of KPC-2-producing Klebsiella pneumoniae sequence type 258 in a hospital in South Korea. J Clin Microbiol 2013;51:3877-3879. https://doi.org/10.1128/JCM.01730-13
  15. Park JW, Lee E, Lee SJ, Lee H. Status of carbapenemase-pro-ducing enterobacteriaceae incidences in Korea, 2015-2016. Public Health Wkly Rep 2017;10:1243-1247.
  16. Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srini-vasan A, Kallen A, Limbago B, Fridkin S; National Healthcare Safety Network (NHSN) Team and Participating NHSN Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010. Infect Control Hosp Epidemiol 2013;34:1-14.
  17. Korea Centers for Disease Control and Prevention. Standard guidelines for infection prevention and control 2017 [Internet]. Cheongju: Korean Centers for Disease Control and Prevention; 2017 [cited 2017 Dec 15]. Available from: http://cdc.go.kr/CDC/together/CdcKrTogether0302.jsp?menuIds=HOME001-MNU1154-MNU0005-MNU0088&fid=51&q_type=title&q_value=%ED%91%9C%EC%A4%80&cid=75626&pageNum=.
  18. Tacconelli E, De Angelis G, Cataldo MA, Pozzi E, Cauda R. Does antibiotic exposure increase the risk of methicillin-resis-tant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J Antimicrob Chemother 2008;61: 26-38.
  19. Tinelli M, Cataldo MA, Mantengoli E, Cadeddu C, Cunietti E, Luzzaro F, Rossolini GM, Tacconelli E. Epidemiology and genetic characteristics of extended-spectrum $\beta$-lactamase-producing Gramnegative bacteria causing urinary tract infections in long-term care facilities. J Antimicrob Chemother 2012;67:2982-2987. https://doi.org/10.1093/jac/dks300
  20. Tacconelli E, De Angelis G, Cataldo MA, Mantengoli E, Spanu T, Pan A, Corti G, Radice A, Stolzuoli L, Antinori S, Paradisi F, Carosi G, Bernabei R, Antonelli M, Fadda G, Rossolini GM, Cauda R. Antibiotic usage and risk of colonization and infection with antibiotic-resistant bacteria: a hospital populationbased study. Antimicrob Agents Chemother 2009;53:4264-4269. https://doi.org/10.1128/AAC.00431-09
  21. Barlam TF, Cosgrove SE, Abbo LM, MacDougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51-e77. https://doi.org/10.1093/cid/ciw118
  22. Kim HI, Kim SW, Chang HH, Kim HB. A survey of antimicrobial stewardship programs in Korean hospitals. Korean J Med 2014;87:173-181. https://doi.org/10.3904/kjm.2014.87.2.173
  23. Huang SS, Rifas-Shiman SL, Warren DK, Fraser VJ, Climo MW, Wong ES, Cosgrove SE, Perl TM, Pottinger JM, Herwaldt LA, Jernigan JA, Tokars JL, Diekema DJ, Hinrichsen VL, Yokoe DS, Platt R; Centers for Disease Control and Prevention Epicenters Program. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330-338. https://doi.org/10.1086/510622
  24. Huskins WC, Huckabee CM, O'Grady NP, Murray P, Kopetskie H, Zimmer L, Walker ME, Sinkowitz-Cochran RL, Jernigan JA, Samore M, Wallace D, Goldmann DA; STAR*ICU Trial Investigators. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:1407-1418. https://doi.org/10.1056/NEJMoa1000373
  25. Septimus E, Weinstein RA, Perl TM, Goldmann DA, Yokoe DS. Approaches for preventing healthcare-associated infections: go long or go wide? Infect Control Hosp Epidemiol 2014;35:797-801. https://doi.org/10.1086/676535
  26. Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the Joint SHEA and APIC Task Force. Am J Infect Control 2007;35:73-85. https://doi.org/10.1016/j.ajic.2007.01.001
  27. Vos MC, Behrendt MD, Melles DC, Mollema FP, de Groot W, Parlevliet G, Ott A, Horst-Kreft D, van Belkum A, Verbrugh HA. 5 Years of experience implementing a methicillin-resistant Staphylococcus aureus search and destroy policy at the largest university medical center in the Netherlands. Infect Control Hosp Epidemiol 2009;30:977-984. https://doi.org/10.1086/605921
  28. Hayden MK, Lin MY, Lolans K, Weiner S, Blom D, Moore NM, Fogg L, Henry D, Lyles R, Thurlow C, Sikka M, Hines D, Weinstein RA; Centers for Disease Control and Prevention Epicenters Program. Prevention of colonization and infection by Klebsiella pneumoniae carbapenemase-producing enterobacteriaceae in long-term acute-care hospitals. Clin Infect Dis 2015;60:1153-1161. https://doi.org/10.1093/cid/ciu1173
  29. Schwaber MJ, Lev B, Israeli A, Solter E, Smollan G, Rubinovitch B, Shalit I, Carmeli Y; Israel Carbapenem-Resistant Ente-robacteriaceae Working Group. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52:848-855. https://doi.org/10.1093/cid/cir025
  30. Kim NH, Han WD, Song KH, Seo HK, Shin MJ, Kim TS, Park KU, Ahn S, Yoo JS, Kim ES, Kim HB. Successful containment of carbapenem-resistant Enterobacteriaceae by strict contact precautions without active surveillance. Am J Infect Control 2014;42:1270-1273. https://doi.org/10.1016/j.ajic.2014.09.004
  31. Ben-David D, Maor Y, Keller N, Regev-Yochay G, Tal I, Shachar D, Zlotkin A, Smollan G, Rahav G. Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection. Infect Control Hosp Epidemiol 2010;31:620-626. https://doi.org/10.1086/652528
  32. World Health Organization. Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health care facilities [Internet]. Geneva: World Health Organization; 2017 [cited 2017 Dec 15]. Available from: http://www.who.int/infection-prevention/publications/guidelines-cre/en/.
  33. Tacconelli E, Cataldo MA, Dancer SJ, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodriguez-Bano J, Singh N, Venditti M, Yokoe DS, Cookson B; European Society of Clinical Microbiology. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014;20 Suppl 1:1-55.
  34. Korea Centers for Disease Control and Prevention. Guidelines for Healthcare Associated Infection Prevention and Control (VRSA, CRE) [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2017 [cited 2017 Dec 15]. Available from: http://cdc.go.kr/CDC/cms/content/mobile/74/74974_view.html
  35. Santos RP, Mayo TW, Siegel JD. Healthcare epidemiology: active surveillance cultures and contact precautions for control of multidrug-resistant organisms: ethical considerations. Clin Infect Dis 2008;47:110-116. https://doi.org/10.1086/588789
  36. Diekema DJ, Pfaller MA. Rapid detection of antibiotic-resistant organism carriage for infection prevention. Clin Infect Dis 2013;56:1614-1620. https://doi.org/10.1093/cid/cit038
  37. Anderson DJ, Chen LF, Weber DJ, Moehring RW, Lewis SS, Triplett PF, Blocker M, Becherer P, Schwab JC, Knelson LP, Lokhnygina Y, Rutala WA, Kanamori H, Gergen MF, Sexton DJ; CDC Prevention Epicenters Program. Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 2017;389:805-814. https://doi.org/10.1016/S0140-6736(16)31588-4
  38. O'Fallon E, Gautam S, D'Agata EM. Colonization with multidrug-resistant gram-negative bacteria: prolonged duration and frequent cocolonization. Clin Infect Dis 2009;48:1375-1381. https://doi.org/10.1086/598194

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