Carbapenemase-Producing Organism and Vancomycin-Resistant Enterococcus Management

Carbapenemases, with versatile hydrolytic capacity against β-lactams, are now an important cause of resistance of Gram-negative bacteria. Furthermore, they are often resistant to a wide-range of antimicrobial agents The genes encoding for the acquired carbapenemases are associated with a high potential for dissemination. In addition, infections due to Gram-negative bacteria with acquired carbapenemase production would lead to high clinical mortality rates. These organisms often render standard empiric therapy ineffective. In fact, Zilberberg et al. demonstrated a higher rate of inappropriate empiric therapy leading to increased length of stay, mortality risk and hospital costs for carbapenem resistant organisms vs susceptible organisms.

The control of the VRE emergence became a priority to tackle the antibiotic resistance, fearing a transfer of the resistance to the methicillin-resistant Staphylococcus aureus (MRSA). VRE outbreaks were reported in CHUGA. Because of the high transmission potential, those VRE outbreaks had a substantial impact on the healthcare activity.

Hypothesis: a better, faster and more accurate identification of VRE and CPE would allow faster appropriate therapy for patients and/or infection control strategies. Faster appropriate therapy could improve mortality rates, length of stay, and other patient outcomes as well as hospital costs.

The primary objective of this study will be to measure the impact of the BD CPO and VRE PCRs on the turnaround time for eXDR positive detection.

A before and after study design will be used. Investigators will compare the average turnaround time before and after the implementation of BD solutions.

Turnaround time is defined as time from sample collection to result delivered to the clinician and/or infection control team.

Result is defined as the detection of the major carbapenemase genes, including blaKPC, blaOXA-48, blaVIM and blaNDM genes or the detection of vanA gene associated to E. faecium identification from fecal swabs.

Inclusion criteria

Anybody coming in the CHUGA with at least one criteria of eXDR screening:

• Hospitalized patients at least two times within the previous year
• Patient transferred from another hospital
• Patient transferred from nursing home
• Patient with a history of hospitalization abroad (foreign countries) within the previous year
• Contact patient = patient exposed to an eXDR bacteria carrier
• eXDR carrier

Exclusion criteria

• Refusal to participate to the study. Opposition of the patients to the use of their personal data.
• Refusal of rectal swab