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Am J Infect Control. 2014 Jul;42(7):739-43. doi: 10.1016/j.ajic.2014.04.003.

Are strict isolation policies based on susceptibility testing actually effective in the prevention of the nosocomial spread of multi-drug-resistant gram-negative rods?

Author information

1
Disease Control and Prevention Center, National Center for Global Health and Medicine, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan; Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan.
2
Division of Infectious Diseases, Shizuoka Cancer Center, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan.
3
Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan.
4
Department of Clinical Infectious Diseases, Aichi Medical University Graduate School of Medicine, Nagakute, Aichi, Japan. Electronic address: mikamo@aichi-med-u.ac.jp.

Abstract

BACKGROUND:

The emergence of multi-drug-resistant gram-negative rods (MDR-GNRs) has become a worldwide problem. To limit the emergence of MDR-GNRs, a tertiary care cancer center in Japan implemented a policy that requires the pre-emptive isolation of patients with organisms that have the potential to be MDR-GNRs.

METHODS:

A retrospective analysis was performed. Any gram-negative bacillus isolates categorized as intermediate or resistant to at least 2 classes of antimicrobials were subjected to contact precautions. The incidence of patients with MDR-GNRs was analyzed.

RESULTS:

There was no difference between the preintervention and intervention time periods in the detection rate of nonfermenting MDR-GNR species (0.15 per 10,000 vs 0.35 per 10,000 patient-days, P = .08). There was an increase in the detection rate of multi-drug-resistant Enterobacteriaceae (0.19 per 10,000 vs 0.56 per 10,000 patient-days, P = .007), which was prominent for extended-spectrum β-lactamase (ESBL)-producing organisms (0.19 per 10,000 vs 0.50 per 10,000 patient-days, P = .02).

CONCLUSIONS:

Our intervention kept the emergence of multi-drug-resistant non-glucose-fermenting gram-negative bacilli to a small number, but it failed to prevent an increase in ESBL producers. Policies, such as active detection and isolation, are warranted to decrease the incidence of these bacilli.

KEYWORDS:

Isolation; Multi–drug-resistant gram negative bacilli; Precaution

PMID:
24969125
DOI:
10.1016/j.ajic.2014.04.003
[Indexed for MEDLINE]

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