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Cocker D, Birgand G, Zhu N, Rodriguez-Manzano J, Ahmad R, Jambo K, Levin AS, Holmes A. Healthcare as a driver, reservoir and amplifier of antimicrobial resistance: opportunities for interventions. Nat Rev Microbiol 2024; 22:636-649. [PMID: 39048837 DOI: 10.1038/s41579-024-01076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
Antimicrobial resistance (AMR) is a global health challenge that threatens humans, animals and the environment. Evidence is emerging for a role of healthcare infrastructure, environments and patient pathways in promoting and maintaining AMR via direct and indirect mechanisms. Advances in vaccination and monoclonal antibody therapies together with integrated surveillance, rapid diagnostics, targeted antimicrobial therapy and infection control measures offer opportunities to address healthcare-associated AMR risks more effectively. Additionally, innovations in artificial intelligence, data linkage and intelligent systems can be used to better predict and reduce AMR and improve healthcare resilience. In this Review, we examine the mechanisms by which healthcare functions as a driver, reservoir and amplifier of AMR, contextualized within a One Health framework. We also explore the opportunities and innovative solutions that can be used to combat AMR throughout the patient journey. We provide a perspective on the current evidence for the effectiveness of interventions designed to mitigate healthcare-associated AMR and promote healthcare resilience within high-income and resource-limited settings, as well as the challenges associated with their implementation.
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Affiliation(s)
- Derek Cocker
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
| | - Gabriel Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins, Nantes, France
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Cibles et medicaments des infections et de l'immunitée, IICiMed, Nantes Universite, Nantes, France
| | - Nina Zhu
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Jesus Rodriguez-Manzano
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Infectious Disease, Imperial College London, London, UK
| | - Raheelah Ahmad
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK
- Department of Health Services Research & Management, City University of London, London, UK
- Dow University of Health Sciences, Karachi, Pakistan
| | - Kondwani Jambo
- Malawi-Liverpool-Wellcome Research Programme, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Anna S Levin
- Department of Infectious Disease, School of Medicine & Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Alison Holmes
- David Price Evans Infectious Diseases & Global Health Group, University of Liverpool, Liverpool, UK.
- National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, London, UK.
- Department of Infectious Disease, Imperial College London, London, UK.
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Martinot M, Schieber A, Ongagna JC, Henric A, Eyriey M, Mohseni-Zadeh M, Ion C, Demesmay K, Gravier S, Kempf C. Clinical features and outcomes in adults with COVID-19 during the pre-Omicron and Omicron waves. Infect Dis Now 2024; 54:104833. [PMID: 37972817 DOI: 10.1016/j.idnow.2023.104833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES We conducted a single-center retrospective study to compare patient characteristics and death rates during the Omicron (O, December 01, 2021, to September 30, 2022) and pre-Omicron (PO, March 01, 1920, to October 31, 2021) periods. PATIENTS AND METHODS We retrospectively analyzed the data of 2932 patients (1242 (O) and 1690 (PO)) hospitalized (>24 h) with laboratory-confirmed COVID. RESULTS Compared to the PO period, O period patients were less frequently men, had a lower body mass index and fewer comorbidities except for immunosuppression and pregnancy. Nosocomial COVID-19 accounted for 18.2 % (O) and 15.4 % (PO) of cases (p = 0.05). Patient mortality rates during the O and PO periods were 11.0 % and 16.9 % (p < 0.001), respectively. Unvaccinated status (p < 0.001), existence of comorbidities, (p < 0.001) and high LDH value at baseline (p = 0.015), but not the period, were identified as factors likely to explain death. CONCLUSION During the Omicron period, the inpatient death rate remained > 10 %, especially among unvaccinated and comorbid patients. Nosocomial cases were more frequent.
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Affiliation(s)
- M Martinot
- Infectious Disease Department, Hôpitaux Civils de Colmar, Colmar, France.
| | - A Schieber
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - J C Ongagna
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - A Henric
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M Eyriey
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M Mohseni-Zadeh
- Infectious Disease Department, Hôpitaux Civils de Colmar, Colmar, France
| | - C Ion
- Infectious Disease Department, Hôpitaux Civils de Colmar, Colmar, France
| | - K Demesmay
- Pharmacy Department, Hôpitaux Civils de Colmar, Colmar, France
| | - S Gravier
- Infectious Disease Department, Hôpitaux Civils de Colmar, Colmar, France
| | - C Kempf
- Clinical Research Department, Hôpitaux Civils de Colmar, Colmar, France
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Martinot M, Mohseni-Zadeh M, Gravier S, Ion C, Eyriey M, Beigue S, Coutan C, Ongagna JC, Henric A, Schieber A, Jochault L, Kempf C. Nosocomial Coronavirus Disease 2019 during 2020-2021: Role of Architecture and Ventilation. Healthcare (Basel) 2023; 12:46. [PMID: 38200952 PMCID: PMC10779121 DOI: 10.3390/healthcare12010046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/16/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
Nosocomial coronavirus disease 2019 (COVID-19) is a major airborne health threat for inpatients. Architecture and ventilation are key elements to prevent nosocomial COVID-19 (NC), but real-life data are challenging to collect. We aimed to retrospectively assess the impact of the type of ventilation and the ratio of single/double rooms on the risk of NC (acquisition of COVID-19 at least 48 h after admission). This study was conducted in a tertiary hospital composed of two main structures (one historical and one modern), which were the sites of acquisition of NC: historical (H) (natural ventilation, 53% single rooms) or modern (M) hospital (double-flow mechanical ventilation, 91% single rooms). During the study period (1 October 2020 to 31 May 2021), 1020 patients presented with COVID-19, with 150 (14.7%) of them being NC (median delay of acquisition, 12 days). As compared with non-nosocomial cases, the patients with NC were older (79 years vs. 72 years; p < 0.001) and exhibited higher mortality risk (32.7% vs. 14.1%; p < 0.001). Among the 150 NC cases, 99.3% were diagnosed in H, mainly in four medical departments. A total of 73 cases were diagnosed in single rooms versus 77 in double rooms, including 26 secondary cases. Measured air changes per hour were lower in H than in M. We hypothesized that in H, SARS-CoV-2 transmission was favored by short-range transmission within a high ratio of double rooms, but also during clusters, via far-afield transmission through virus-laden aerosols favored by low air changes per hour. A better knowledge of the mechanism of airborne risk in healthcare establishments should lead to the implementation of corrective measures when necessary. People's health is improved using not only personal but also collective protective equipment, i.e., ventilation and architecture, thereby reinforcing the need to change institutional and professional practices.
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Affiliation(s)
- Martin Martinot
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.M.-Z.); (S.G.); (C.I.); (S.B.)
| | - Mahsa Mohseni-Zadeh
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.M.-Z.); (S.G.); (C.I.); (S.B.)
| | - Simon Gravier
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.M.-Z.); (S.G.); (C.I.); (S.B.)
| | - Ciprian Ion
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.M.-Z.); (S.G.); (C.I.); (S.B.)
| | - Magali Eyriey
- Clinical Research Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.E.); (J.-C.O.); (A.H.); (A.S.); (C.K.)
| | - Severine Beigue
- Infectious Diseases Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.M.-Z.); (S.G.); (C.I.); (S.B.)
| | - Christophe Coutan
- Technical Department, Hôpitaux Civils de Colmar, 68000 Colmar, France;
| | - Jean-Claude Ongagna
- Clinical Research Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.E.); (J.-C.O.); (A.H.); (A.S.); (C.K.)
| | - Anais Henric
- Clinical Research Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.E.); (J.-C.O.); (A.H.); (A.S.); (C.K.)
| | - Anne Schieber
- Clinical Research Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.E.); (J.-C.O.); (A.H.); (A.S.); (C.K.)
| | - Loic Jochault
- Medical Information Service, Hôpitaux Civils de Colmar, 68000 Colmar, France;
| | - Christian Kempf
- Clinical Research Department, Hôpitaux Civils de Colmar, 68000 Colmar, France; (M.E.); (J.-C.O.); (A.H.); (A.S.); (C.K.)
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