25 Lug Antimicrobial stewardship and universal screening are essential components of a stepwise approach to contain the spread of carbapenemase producing Klebsiella pneumoniae (CPKP)

BACKGROUND
There is little evidence for effective strategies to contain the spread of carbapenemase producing Klebsiella pneumoniae (CPKP) in hospital settings with a high endemicity. Our aim was to define the effectiveness of sequential infection control measures to reduce the spread of CPKP.
METHODS
A quasi-experimental (not randomly assigned), before- and after-interrupted time series analysis was performed from 2009 to 2014. Between 2009 and 2011, infection control procedures consisted of contact precautions and room isolations of CPKP-infected patients (phase I); from 2012 through 2013, targeted screening in high risk patients and audit of hand hygiene (HH) compliance were added (phase II); in 2014, universal screening in high risk wards and antibiotic stewardship (ABS) controlling carbapenem use were introduced (phase III).
Primary outcome was the incidence rate (IR) of nosocomial acquisition of CPKP (cases/ 1,000 patient-days). The efficacy of the consecutive interventional phases (I-III) was evaluated using other multiple monthly quantifiable outcomes.
RESULTS
The stepwise introduction and extension of infection control measures led to a progressive hospital-wide decrease in the incidence of CPKP colonizations and BSI. After the third interventional period, CPKP IR decreased significantly by 39.7% for colonizations and by 83.3% for BSI (p< 0.001).
CONCLUSION
Universal screening and ABS in high-risk areas of the hospital are the cornerstones to reduce the spread of CPKP in endemic settings.