Strategie di prevenzione e controllo delle infezioni da Klebsiella pneumoniae multidrug resistant correlate alla assistenza: programma di intervento in un presidio ospedaliero

Background:Targeted actions of infection control on hospital institutions’ local epidemiology and resources are required to contain carbapenemase-producing Klebsiella pneumoniae(KPC-Kp). Materials/methods:An interchange protocol with the Infectious Diseases Unit of Modena Polyclinic was started to verify the feasibility of "Anti-KPC-Kp bundle" in the setting of S.M. Goretti Hospital of Latina(a tertiary university care centre with a high endemicity of KPC-Kp). A dedicated multidisciplinary working group was set up. Standardized indexes were defined to evaluate setting modifications and proposed targets in 3 high-risk wards(Intensive Care Unit(ICU), Emergency Medicine, Neurosurgery): -active surveillance of rectal colonization; -handwashing adherence assessments; -alcohol solution consumptions, L/1000patient-days(PD); -meropenem Defined Daily Dose(DDD)/100PD; Statistical analysis:Indexes modifications are shown in percentages or changes in level (average±SD). A Poisson regression model was applied to analyse the trend of KPC-Kp prevalence in ICU, Emergency Medicine and Neurosurgery. Only for ICU, a Poisson regression model was applied also to analyse the trend of the incidence density rates, considering the total hospitalization days as an offset in the model. Active control by participative focus groups among healthcare workers ensured the continuous implementation of the bundle. Results:At baseline carbapenem resistance in all Kp hospital’s blood cultures was 71,4% (in ICU 87,5%). KPC-Kp prevalence reported monthly on the first day showed a dramatic reduction (Figure 1). Results from the Poisson regression models showed a statistically significant negative trend of prevalence in ICU (p<0.001) and Emergency Medicine (p=0.021), but not in Neurosurgery (p=0.259). A statistically significant negative trend was also found for incidence density rates in ICU (p=0.007). At basal, handwashing adherence in ICU was 59,3%. Further assessments are scheduled after starting a structured training program. An increase of alcoholic hand rub consumption was observed from 14,2(SD±7,56)to 33,59(SD±13,11). A slight decrease of meropenem DDD was observed from 19,53(SD±16,98)to 14,09(SD±9,72). Conclusions: After 8 months, an improvement of the indexes was observed. The exported model based on a multimodal approach exerted a rapid effect on Kp-KPC diffusion in the intensive area of the hospital, also in a different situation of high basal prevalence. A longer follow-up is necessary to confirm these data together with a more detailed carbapenem resistance rates’ analysis.