Potential role of active surveillance in the control of a hospital-wide outbreak of carbapenem-resistant Klebsiella pneumoniae infection

Infect Control Hosp Epidemiol. 2010 Jun;31(6):620-6. doi: 10.1086/652528.


Background: The recent emergence of carbapenem resistance among Enterobacteriaceae is a major threat for hospitalized patients, and effective strategies are needed.

Objective: To assess the effect of an intensified intervention, which included active surveillance, on the incidence of infection with carbapenem-resistant Klebsiella pneumoniae.

Setting: Sheba Medical Center, a 1,600-bed tertiary care teaching hospital in Tel Hashomer, Israel.

Design: Quasi-experimental study.

Methods: The medical records of all the patients who acquired a carbapenem-resistant K. pneumoniae infection during 2006 were reviewed. An intensified intervention was initiated in May 2007. In addition to contact precautions, active surveillance was initiated in high-risk units. The incidence of clinical carbapenem-resistant K. pneumoniae infection over time was measured, and interrupted time-series analysis was performed.

Results: The incidence of clinical carbapenem-resistant K. pneumoniae infection increased 6.42-fold from the first quarter of 2006 up to the initiation of the intervention. In 2006, of the 120 patients whose clinical microbiologic culture results were positive for carbapenem-resistant K. pneumoniae, 67 (56%) developed a nosocomial infection. During the intervention period, the rate of carbapenem-resistant K. pneumoniae rectal colonization was 9%. Of the 390 patients with carbapenem-resistant K. pneumoniae colonization or infection, 204 (52%) were identified by screening cultures. There were a total of 12,391 days of contact precautions, and of these, 4,713 (38%) were added as a result of active surveillance. After initiation of infection control measures, we observed a significant decrease in the incidence of carbapenem-resistant K. pneumoniae infection.

Conclusions: The use of active surveillance and contact precautions, as part of a multifactorial intervention, may be an effective strategy to decrease rates of nosocomial transmission of carbapenem-resistant K. pneumoniae colonization or infection.

MeSH terms

  • Carbapenems / pharmacology*
  • Carbapenems / therapeutic use
  • Communicable Disease Control / methods
  • Communicable Disease Control / organization & administration
  • Cross Infection / epidemiology*
  • Cross Infection / prevention & control
  • Disease Outbreaks / prevention & control*
  • Drug Resistance, Bacterial / drug effects*
  • Electrophoresis, Gel, Pulsed-Field
  • Hospital Mortality
  • Hospitals, Teaching
  • Humans
  • Israel
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / mortality
  • Klebsiella Infections / transmission
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / genetics
  • Population Surveillance / methods*


  • Carbapenems