Tracking colonized patients by carbapenem resistant Enterobacteriacea and providing early contact precautions at the Emergency Department

• Grant number: 18/06016-0
• Support Opportunities: Regular Research Grants
• Duration: March 01, 2019 - February 28, 2021
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Icaro Boszczowski
• Grantee: Icaro Boszczowski
• Host Institution: Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated researchers: Alberto José da Silva Duarte ; Aluisio Augusto Cotrim Segurado ; Anna Sara Shafferman Levin ; Matias Chiarastelli Salomão ; Silvia Figueiredo Costa

Abstract

Carbapenem Resistant Enterobacteriaceae (ERC) are a major infection control concern to the hospital. A recent study in our emergency department (ED) demonstrated that 6.8% of patients admitted to the ED are colonized by ERC with an acquisition rate of 18%. The objective of this study is to evaluate the impact of an intervention designed to stop the spread of ERC in the ED.The study will take place in the ED in a 3 month period. All patients admitted to the ED that present risk factors for ERC colonization will be screened for ERC intestinal carriage with rectal swabs for real-time PCR (Rt-PCR) for carbapenemases (KPC, NDM, OXA-48, VIM, and IMP) and culture. Patients will be put under contact precautions until results of the Rt-PCR, and isolated from the rest of the emergency department. Patients who are negative will be released from contact precautions and will be screened weekly for ERC carriage using the same methods. Patients who are positive will be separated from the other patients and will remain under contact precautions. The incidence of ERC colonization will be evaluated before and after the intervention. All positive isolates will be submitted to whole genome sequencing. Clonality and antimicrobial resistance genes will be analyzed. (AU)