dc.contributor |
Universitat de Barcelona |
dc.contributor.author |
Suarez, Cristina |
dc.contributor.author |
Peña Miralles, Carmen |
dc.contributor.author |
Arch, Olga |
dc.contributor.author |
Domínguez Luzón, Ma. Ángeles (María Ángeles) |
dc.contributor.author |
Tubau, Fe |
dc.contributor.author |
Juan, Carlos |
dc.contributor.author |
Gavaldá, Laura |
dc.contributor.author |
Sora, Mercedes |
dc.contributor.author |
Oliver, Antonio |
dc.contributor.author |
Pujol Rojo, Miquel |
dc.contributor.author |
Ariza Cardenal, Javier |
dc.date |
2018-01-25T09:52:49Z |
dc.date |
2018-01-25T09:52:49Z |
dc.date |
2011-10-13 |
dc.date |
2018-01-25T09:52:49Z |
dc.identifier.citation |
1471-2334 |
dc.identifier.citation |
607929 |
dc.identifier.uri |
http://hdl.handle.net/2445/119284 |
dc.format |
8 p. |
dc.format |
application/pdf |
dc.language.iso |
eng |
dc.publisher |
BioMed Central |
dc.relation |
Reproducció del document publicat a: https://doi.org/10.1186/1471-2334-11-272 |
dc.relation |
Bmc Infectious Diseases, 2011, vol. 11, p. 272 |
dc.relation |
https://doi.org/10.1186/1471-2334-11-272 |
dc.rights |
cc-by (c) Suarez, Cristina et al., 2011 |
dc.rights |
info:eu-repo/semantics/openAccess |
dc.rights |
http://creativecommons.org/licenses/by/3.0/es |
dc.subject |
Pseudomonas |
dc.subject |
Epidemiologia |
dc.subject |
Infeccions nosocomials |
dc.subject |
Higiene hospitalària |
dc.subject |
Pseudomonas |
dc.subject |
Epidemiology |
dc.subject |
Nosocomial infections |
dc.subject |
Hospital hygiene |
dc.title |
A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition |
dc.type |
info:eu-repo/semantics/article |
dc.type |
info:eu-repo/semantics/publishedVersion |
dc.description.abstract |
Background: Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied. Methods: Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented. Results: Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more. Conclusions: In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem. |