Stewardship / Resistance Scan for Dec 27, 2016

Carbapenem-resistant Klebsiella
Copper oxide and HAIs

Study: 25% of K pneumonia in long-term care resistant to carbapenems

A new study has found that a quarter of Klebsiella pneumoniae isolates from a nationwide network of hospitals are resistant to carbapenem antibiotics.

According to a Dec 24 study in Clinical Infectious Diseases, 946 of 3,846 K pneumoniae isolates collected at 64 geographically widespread long-term acute care hospitals from January 2014 to March 2015 were carbapenem resistant, for an overall carbapenem resistance rate of 24.6%. While carbapenem-resistant K pneumoniae (CRKP) rates varied widely across 16 states, the highest rates were observed in California (45.5%), South Carolina (35.7%), Kentucky (22.1%), and Indiana (20%).

Of the US census regions, the West had the highest proportion of CRKP isolates (42.2%), followed by the South (12.2%), the Northeast (9.9%), and the Midwest (7.3%).

The 946 CRKP isolates came from 821 patients with a median age of 73 years and several comorbidities, including respiratory failure, advanced stage decubitus ulcers, and severe end-stage kidney disease. More than half of the patients had either a central venous catheter or a urinary catheter. CRKP isolates were primarily from respiratory (58.9%) and urinary (37%) sources.

In addition to being carbapenem resistant, the CRKP isolates were also found to be highly resistant to other commonly used broad-spectrum antibiotic agents, with more than 97% showing resistance to ciprofloxacin, levofloxacin, gentamicin, and tobramycin, and 59.2% demonstrating resistance to amikacin. Of significant concern, 16.1% of 700 tested isolates showed resistance to the last-line antibiotics colistin or polymixin B.

The authors note that the 25% carbapenem resistance rate is substantially higher than the rate of 10.4% reported in a previous study of ICU-associated infections from acute care hospitals, and is likely under-reported because rectal cultures for detection of asymptomatic gastrointestinal colonization were not routinely performed.

"Along these lines, it is clear that the epidemiology of CRKP in the U.S. is rapidly evolving, and enhanced surveillance and reporting is needed across the healthcare continuum," the authors wrote.
Dec 24 Clin Infect Dis study 

Copper oxide-embedded textiles help reduce healthcare-related infections

A study yesterday in the American Journal of Infection Control suggests that using copper oxide-impregnated biocidal textiles in long-term care medical facilities can reduce healthcare-associated infections (HAIs).

The 7-month study involved all patients in two ventilator-dependent wards at a long-term care hospital. In the first intervention period, investigators replaced all the textiles (lines, patients' clothes, and towels) in one ward with copper-oxide impregnated textiles, while the other ward used regular hospital textiles. Previous studies have shown that embedding nonsoluble copper oxide in textiles permanently endows them with potent broad-spectrum antimicrobial properties.

After a 1-month washout period, in which both wards used regular textiles, the investigators then switched the textiles in the two wards for the second intervention period, with the ward that received the treated textiles in period one getting the control textiles, and vice versa. Hospital personnel were blinded to which ward received the treated textiles and which received the control textiles, and all standard infection control measures were observed in both wards. In addition, the characteristics of the patients in the two wards were roughly the same.

At the end of the study, investigators observed significant reductions in HAI indicators in the wards when copper-treated textiles were used, including a 29.3% reduction in antibiotic treatment initiation events, a 55.5% decrease in fever days, a 23% drop in days of antibiotic treatment, and a 27.5% decrease in antibiotic defined daily doses per 1,000 hospitalization days.

"Our study adds an important layer to the in vitro studies and the previous open-label studies supporting the effect of copper oxide–impregnated medical textiles as a possible supplement to other measures aimed at reducing the rate of HAIs," the authors wrote.           
Dec 26 Am J Infect Control study

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