Background: Antimicrobial resistance (AMR) is recognized as one of the most important global public health threats. There is an urgent need to reduce the spread of these multidrug-resistant bacteria (MDR-B), particularly in extremely vulnerable patients. The aim of this study was to investigate whether targeted gene amplification performed directly on clinical samples can be used simultaneously with a bundle of enhanced infection control measures in a Pediatric Intensive Care Unit (PICU) endemic to MDR-B. Methods: This study had three phases: (1) the baseline phase was performed prior to intervention when first screening and sample collection were performed; (2) the intervention phase was performed when various enhanced infection control measures (EICM) were applied; and (3) the maintenance phase occurred when EICMs were combined with the implementation of targeted molecular surveillance. The presence of four carbapenemase genes, bla_KPC, bla_OXA-48-like, bla_VIM, and bla_NDM, as well as the β-lactamase genes bla_TEM and bla_SHV, was evaluated by PCR after DNA isolation directly from stool samples. The results were compared to culture-based phenotypic analysis. Results and Conclusions: The implementation of EICM appeared to reduce the resistance burden in this sample endemic to an MDR-B clinical setting. The direct implementation of a targeted and customized rapid molecular detection assay to clinical samples seems to be an effective clinical tool for the evaluation of EICM measures.

Background: Antimicrobial drug resistance is recognized as one of the most important global public health threats. There is an urgent need to reduce the spread of the multidrug-resistant bacteria (MDR-B) bacteria, particularly in clinically extremely vulnerable patients. The aim of this study was to investigate whether targeted gene amplification directly on clinical samples can be used as a rapid and effective tool for active surveillance of antimicrobial resistance in a Pediatric Intensive Care Unit (PICU). Methods: The study had three phases: 1) The Baseline phase performed prior to intervention, when first screening and sample collection was performed, 2) the Intervention phase, when a bundle of enhanced infection control measures (EICM) was applied, and 3) the Maintenance phase when enhanced infection control measures were combined with the implementation of the targeted molecular surveillance. The presence of four carbapenemases: blaKPC, blaOXA-48-like, blaVIM, and blaNDM as well as of blaTEM and blaSHV were evaluated by PCR after DNA isolation directly from stool samples. Results were compared to culture-based phenotypic analysis. Results and Conclusions: The applied EICM led to decreased colonization of blaKPC, blaVIM and blaTEM . Implementation of EICM has been shown that it may reduce the resistance burden in this clinical setting endemic to MDR-B. Direct implementation of a targeted and customized rapid molecular detection assay to clinical samples seems to be an effective clinical tool for the evaluation of antimicrobial stewardship measures.