Infection-prevention and control interventions to reduce colonisation and infection of intensive care unit-acquired carbapenem-resistant Klebsiella pneumoniae: a 4-year quasi-experimental before-and-after study

Meiling Li†,
Xiaoli Wang†,
Jiahui Wang,
Ruoming Tan,
Jingyong Sun,
Lei Li,
Jie Huang,
Jun Wu,
Qiuying Gu,
Yujin Zhao,
Jialin LiuEmail author and
Hongping QuEmail author View ORCID ID profile

†Contributed equally

Antimicrobial Resistance & Infection Control20198:8

https://doi.org/10.1186/s13756-018-0453-7

Received: 29 October 2018
Accepted: 12 December 2018
Published: 10 January 2019

Abstract

Objective

To determine whether infection-prevention and control (IPC) interventions can reduce the colonisation and infection of intensive care unit (ICU)-acquired carbapenem-resistant Klebsiella pneumoniae (CRKP) in a general ICU ward in China.

Methods

We used a quasi-experimental before-and-after study design. The study was conducted in 4 stages: baseline period, January 2013–June 2013; IPC interventions period including de-escalation and targeted bundle interventions, July 2013–June 2014; modified IPC interventions period, July 2014–June 2015; and follow-up period, July 2015–June 2016. We used modified de-escalation interventions according to patient-risk assessments to prevent the transmission of CRKP.

Results

A total of 629 patients were enrolled in study. The incidence of ICU-acquired CRKP colonisation/infection was 10.08 (4.43–16.43) per 1000 ICU patient-days during the baseline period, and significantly decreased early during the IPC interventions, but the colonisation/infections reappeared in April 2014. During the modified IPC intervention and follow-up periods, the incidence of ICU-acquired CRKP colonisations/infections reduced to 5.62 (0.69–6.34) and 2.84 (2.80–2.89), respectively, with ongoing admission of cases with previously acquired CRKP. The incidence of ICU-acquired CRKP catheter-related bloodstream infections decreased from 2.54 during the baseline period to 0.41 during the follow-up period. The incidence of ventilator-associated pneumonia and skin and soft tissue infections showed a downward trend from 2.84 to 0.41 and from 3.4 to 0.47, respectively, with slight fluctuations.

Conclusions

Comprehensive IPC interventions including de-escalation and targeted bundle interventions showed a significant reduction in ICU-acquired CRKP colonisations/infections, despite ongoing admission of patients colonised/infected with CRKP.