Management of Carbapenemase-Producing Enterobacteriaceae

Infection Control Measures

The Centers for Disease Control and Prevention recommends that all patients colonized or infected with carbapenemase-producing enterobacteriaceae be placed immediately in contact precautions, regardless of whether they exhibit clinical symptoms of infection 1, 2, 3, 4, 5
The American College of Physicians suggests isolating the patient in a single room to reduce the risk of nosocomial transmission 6
The Infectious Diseases Society of America recommends maintaining contact precautions throughout the patient's hospitalization 6
The World Health Organization advises that healthcare personnel wear gowns and gloves before entering the patient's room and remove them immediately after contact, followed by hand hygiene 6

The Centers for Disease Control and Prevention recommends implementing hand hygiene with alcohol-based solutions before and after each patient contact (inadequate adherence of 48% in documented outbreaks contributed to spread) 3, 4, 6
The World Health Organization suggests using water and soap when hands are visibly soiled 6

The Centers for Disease Control and Prevention recommends immediate notification of the infection control and epidemiology team upon identification of a patient with carbapenemase-producing enterobacteriaceae 3, 4, 5
The American College of Physicians advises establishing alert codes to rapidly identify previously known colonized patients in future admissions 6

The Centers for Disease Control and Prevention recommends performing active surveillance cultures (rectal swabs) in patients with epidemiological links to the index case (same unit, same healthcare personnel) 1, 3, 5, 6
The Infectious Diseases Society of America notes that unrecognized colonized patients have served as reservoirs during nosocomial outbreaks 3, 4

The European Centre for Disease Prevention and Control recommends identifying the specific type of carbapenemase through rapid molecular tests (KPC, NDM, OXA-48, VIM, IMP) to guide appropriate therapy if the patient develops infection 7
The Centers for Disease Control and Prevention notes that the modified Hodge test (MHT) has sensitivity and specificity >90% for detecting carbapenemase production 2, 4, 8, 7

The Infectious Diseases Society of America recommends ceftazidime/avibactam or meropenem/vaborbactam as first-line treatment for KPC-producing strains 7
The European Centre for Disease Prevention and Control suggests ceftazidime/avibactam as first-line treatment for OXA-48-producing strains 7
The American College of Physicians advises ceftazidime/avibactam plus aztreonam for metallo-β-lactamase (MBL)-producing strains 7

The Centers for Disease Control and Prevention recommends implementing regular environmental cleaning with appropriate detergents or disinfectants 6
The World Health Organization suggests considering environmental sampling of surfaces in contact with the patient during outbreaks 6

The Infectious Diseases Society of America warns against underestimating the importance of asymptomatic colonization: colonized patients without symptoms are important reservoirs of transmission 3, 4
The American College of Physicians advises against delaying the implementation of contact precautions: delayed recognition of colonization contributed to outbreaks with 39 documented cases 3
The Centers for Disease Control and Prevention notes that rectal/perirectal swabs have higher yield than other body sites (nares, skin) 1, 3