ABSTRACT
Carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) infections are an emerging cause of death after hematopoietic stem cell transplantation (HSCT). In allogeneic transplants, mortality rate may rise up to 60%. We retrospectively evaluated 540 patients receiving a transplant from an auto- or an allogeneic source between January 2011 and October 2015. After an Institutional increase in the prevalence of KPC-Kp bloodstream infections (BSI) in June 2012, from July 2012, 366 consecutive patients received the following preventive measures: (i) weekly rectal swabs for surveillance; (ii) contact precautions in carriers (iii) early-targeted therapy in neutropenic febrile carriers. Molecular typing identified KPC-Kp clone ST512 as the main clone responsible for colonization, BSI and outbreaks. After the introduction of these preventive measures, the cumulative incidence of KPC-Kp BSI (P=0.01) and septic shocks (P=0.01) at 1 year after HSCT was significantly reduced. KPC-Kp infection-mortality dropped from 62.5% (pre-intervention) to 16.6% (post-intervention). Day 100 transplant-related mortality and KPC-Kp infection-related mortality after allogeneic HSCT were reduced from 22% to 10% (P=0.001) and from 4% to 1% (P=0.04), respectively. None of the pre-HSCT carriers was excluded from transplant. These results suggest that active surveillance, contact precautions and early-targeted therapies, may efficiently control KPC-Kp spread and related mortality even after allogeneic HSCT.
Subject(s)
Bacterial Proteins/biosynthesis , Hematologic Neoplasms , Hematopoietic Stem Cell Transplantation , Klebsiella Infections , Klebsiella pneumoniae , Shock, Septic , beta-Lactamases/biosynthesis , Adolescent , Adult , Aged , Allografts , Autografts , Female , Follow-Up Studies , Hematologic Neoplasms/mortality , Hematologic Neoplasms/therapy , Humans , Klebsiella Infections/genetics , Klebsiella Infections/mortality , Klebsiella Infections/therapy , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/metabolism , Klebsiella pneumoniae/pathogenicity , Male , Middle Aged , Shock, Septic/genetics , Shock, Septic/mortality , Shock, Septic/therapySubject(s)
Acinetobacter Infections/drug therapy , Acinetobacter baumannii/drug effects , Cross Infection/microbiology , Cross Infection/prevention & control , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/classification , Acinetobacter baumannii/enzymology , Aged , Cross Infection/drug therapy , Disease Outbreaks , Drug Resistance, Bacterial , Genotype , Humans , Intensive Care Units , Italy/epidemiology , Male , Patient Isolation , Patient Transfer , beta-LactamasesABSTRACT
An outbreak of nosocomial legionnaires' disease in a hospital of Northern Italy is described, together with the epidemiological survey and the control measures adopted. Two patients developed Legionella pneumophila (serogroup 1) pneumonia, one (immunodepressed) died. The Task Group organised by the Health Service excluded other previous nosocomial infections, and made controls on patients and personnel of at risk units (all negative). An intensive programme of environmental sampling and educational activities on personnel have been carried out. The environmental surveillance revealed that the centralised hot water distribution system of the hospital was colonised with Legionella. Shock heating and hyperchlorination of water were applied, which reduced the number of contaminated sites short term, but recolonisation took place two months later. We underline the difficulties encountered to control Legionella by active surveillance of water quality; once the system is contamined, Legionella eradication may be difficult and expensive, and cases of hospital-acquired legionnaieres' disease are likely to occur.
Subject(s)
Cross Infection/prevention & control , Disease Outbreaks , Environmental Microbiology , Legionnaires' Disease/prevention & control , Water Microbiology , Water Pollution , Water Purification/methods , Water Supply , Adult , Chlorine , Cross Infection/epidemiology , Cross Infection/transmission , Disinfection/methods , Equipment Contamination , Fatal Outcome , Female , Health Personnel/education , Heating , Hospital Departments , Humans , Italy/epidemiology , Legionnaires' Disease/epidemiology , Legionnaires' Disease/transmission , Maintenance and Engineering, Hospital , Male , Middle Aged , RiskABSTRACT
The incidence of legionella infection in Europe overall in 1997 was 3.9 cases per million population, with the lowest rates reported by Malta and Norway and the highest by Denmark. Ninety cases were reported in Italy (1.5 cases/million), 20% of which were
