gms | German Medical Science

Introduction: The recent emergence of carbapenem-resistant (CR) gram-negative bacteria represents a major threat for hospitalized patients, especially for solid organ transplant (SOT) recipients. Implementation of infection control measures has proven to effectively reduce the cross-transmission between hospitalized patients.

Objectives: Our purpose was to study the incidence of colonization and infection caused by CR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in a solid organ transplantation department. Furthermore, to assess the impact of infection control measures in the incidence of colonization and infections.

Methods: In the Solid Organ Transplantation Department of Hippokration General Hospital of Thessaloniki incidence of colonization and infection caused by these CR bacteria was recorded. The study was divided into 4 periods (retrospective study: March- August 2012 without active surveillance and, prospectively, 1^st period: September 2012- February 2013 with implementation of active surveillance programme (ASP), 2^nd: March- June 2013 and 3^rd: July- December 2013 with enhanced infection control measures). Infection control measures included active surveillance (weekly taken rectal swabs cultured on MacConkey agar containing 1µg/ml meropenem), contact precautions, hand hygiene, education of health care workers (HCWs), audit and feedback.

Results: The incidence of infection caused by these CR bacteria had a statistically significant increase (p<0.001), from approximately 2 to 7.5/ 1000 bed-days. However, this increase had not such a strong trend in the ASP period. During this period, incidence of colonization reduced from approximately 20% to 14% (p=0.088). In the 3^rd period of ASP this reduction was statistically important (p<0.001). The compliance of HCWs with contact precautions and implementation of hand hygiene after patient contact were also improved.

Conclusion: Colonization and infection rates by these CR bacteria were found to be high among SOT recipients. By applying a set of enhanced control measures, a reduction in colonization rates by these bacteria has been achieved.