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CDC measures to detect, stop resistant Klebsiella
The Centers for Disease Control and Prevention guidelines to prevent infection with carbapenem-resistant Wnterobacteri-aceae (CRE) in general and carbapenem-resistant Klebsiella pneumoniae (CRKP) in particular include the following recommendations:
Infection Prevention and Control
• All acute care facilities should implement contact precautions for patients colonized or infected with CRE or carbapenemase-producing Enterobacteriaceae. No recommendation can be made regarding when to discontinue contact precautions.1
• Clinical microbiology laboratories should follow Clinical and Laboratory Standards Institute guidelines for susceptibility testing and establish a protocol for detection of carbapenemase production (e.g., performance of the modified Hodge test).2
• Clinical microbiology laboratories should establish systems to ensure prompt notification of infection prevention staff of all Enterobacteriaeae isolates that are nonsusceptible to carbapenems or Klebsiella spp. (or Escherichia coli isolates that test positive for a carbapenemase).
• All acute care facilities should review clinical culture results for the preceding six to 12 months to determine whether previously unrecognized CRE have been present in the facility.
— If this review identifies previously unrecognized CRE, a point prevalence survey (a single round of active surveillance cultures) should be performed to look for CRE in high-risk units (e.g., intensive care units, units where previous cases have been identified, and units where many patients are exposed to broad-spectrum antimicrobials).
— If this review does not identify previously unrecognized CRE, monitoring for clinical infections should be continued.
• If CRE or carbapenemase-producing Klebsiella spp. or E. coli are detected from one or more clinical cultures OR if the point prevalence survey reveals unrecognized colonization, the facility should investigate for possible transmission by:
— Conducting active surveillance testing of patients with epidemiologic links to a patient with CRE infection (e.g., patients in the same unit or who have been cared for by the same health care personnel).
• Continue active surveillance periodically (e.g., weekly) until no new cases of colonization or infection suggesting cross-transmission are identified.
• If transmission of CRE is not identified after repeated active surveillance testing, consider altering the surveillance strategy by performing periodic point-prevalence surveys in high-risk units.
In areas where CRE are endemic, an increased likelihood exists for importation of CRE, and the procedures outlined might not be sufficient to prevent transmission. Facilities in such areas should monitor clinical cases and consider additional strategies to reduce rates of CRE, as described in the 2006 Tier 2 guidelines for management of multidrug-resistant organisms in health care settings.3 Recommendations for rare calculations have been described previously.4