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Hernández‐Chico I, Rodríguez‐Guerrero E, Expósito‐Ruiz M, Navarro‐Marí J, Gutiérrez‐Fernández J. Reliability of a Screening Method Using Antibiotic Disks to Detect Carbapenemases in Glucose-Nonfermenting Gram-Negative Microorganisms From Clinical Samples of a Regional Hospital in Southeastern Spain. J Clin Lab Anal 2024; 38:e25036. [PMID: 38619303 PMCID: PMC11073814 DOI: 10.1002/jcla.25036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Infections by glucose-nonfermenting gram-negative bacilli (NFGNB) pose a major public health problem due to multiresistance to beta-lactam antibiotics, especially plasmid-borne carbapenemases. Their detection by microbiology laboratories is challenging, and there is a need for easy-to-use and reliable diagnostic techniques. Our objective was to evaluate an in-house screening method to presumptively detect carbapenemases in NFGNB in a simple and clinically useful manner. METHODS The study included 175 NFGNB isolates from urinary, respiratory, and rectal samples. In a triple assay, isolates were incubated at 37°C for 24 h on three solid-culture media: MacConkey II Agar, 5% Sheep Blood Columbia Agar and Mueller Hinton II Agar; meropenem (MEM) and cefepime (FEP) disks were employed for screening. Studies were then performed on the inhibition halo diameter, scanning effects, and the appearance of mutant colonies, which were compared with those observed using the colorimetric Neo-Rapid CARB Kit and immunochromatography (NG5-Test Carba and K-Set for OXA-23). Receiver operating characteristic curves were constructed for these data. RESULTS Carbapenemases were expressed by 79/175 (45.1%): 19 Pseudomonas aeruginosa and 60 Acinetobacter baumannii. Optimal inhibition halo diameter cutoffs to detect this resistance on 5% sheep blood agar were as follows: 6 mm (MEM) and 6.5 mm (FEP) for P. aeruginosa (in the absence of scanning effects and mutations) and 10.5 mm (MEM) and 16 mm (FEP) for A. baumannii (even in the presence of scanning effects). CONCLUSION The combined utilization of MEM and FEP antibiotic disks in 5% sheep blood agar, measuring their inhibition haloes, offers an effective method to predict the presence of carbapenemases as resistance mechanism in P. aeruginosa and A. baumannii.
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Affiliation(s)
- Itahisa Hernández‐Chico
- Departmento de Microbiología, Facultad de MedicinaUniversidad de Granada‐Instituto de Investigación BiosanitariaGranadaSpain
| | - Enrique Rodríguez‐Guerrero
- Departmento de MicrobiologíaHospital Universitario Virgen de las Nieves‐Instituto de Investigación BiosanitariaGranadaSpain
| | - Manuela Expósito‐Ruiz
- Departmento de Estadística, Facultad de MedicinaUniversity of Granada‐Instituto de Investigación BiosanitariaGranadaSpain
| | - José María Navarro‐Marí
- Departmento de MicrobiologíaHospital Universitario Virgen de las Nieves‐Instituto de Investigación BiosanitariaGranadaSpain
| | - José Gutiérrez‐Fernández
- Departmento de Microbiología, Facultad de MedicinaUniversidad de Granada‐Instituto de Investigación BiosanitariaGranadaSpain
- Departmento de MicrobiologíaHospital Universitario Virgen de las Nieves‐Instituto de Investigación BiosanitariaGranadaSpain
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Bopp TC, Marchesi M, Zihlmann R, Sax H, Wolfensberger A. Identifying patients at high risk for multidrug-resistant organisms after hospitalization abroad. Infect Control Hosp Epidemiol 2023; 44:1281-1288. [PMID: 36912341 DOI: 10.1017/ice.2022.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVES We quantified the percentage of multidrug-resistant organism (MDRO) carriers among repatriated patients. We identified factors associated with MDRO carriage, and we evaluated the yield of MDRO detection per screened body site. DESIGN Retrospective cohort study. SETTING A tertiary-care center in Switzerland. PATIENTS Adult patients after a stay in a healthcare institution abroad. METHODS Patients were screened for MDRO carriage. Standard sites, including nose and throat, groins, and (since mid-2018) rectum, and risk-based sites (wounds, urine, tracheal secretion) were sampled. MDROs were defined as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Enterobacterales (CPE), multidrug-resistant (MDR) Enterobacterales, and MDR nonfermenting gram-negative rods. Risk factors for MDRO carriage were assessed using multivariate logistic regression. RESULTS Between May 2017 and April 2019, 438 patients were screened and 107 (24.4%) tested positive for an MDRO, predominantly ESBL-producing and MDR Enterobacterales. Risk factors for MDRO colonization were the length of stay in hospital abroad, antibiotic treatment with 'Watch' and 'Reserve' antibiotics, and region of hospitalization abroad. Rectal swabs had the highest yield for detecting patients with MDR intestinal bacteria, but nose/throat and groins, or wound samples were more sensitive for MRSA or nonfermenting gram-negative organisms, respectively. CONCLUSIONS We identified risk factors for MDRO carriage and body sites with the highest yield for a specific MDRO, which might help to target screening and isolation and reduce screening costs.
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Affiliation(s)
- Tamara C Bopp
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
| | - Martina Marchesi
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Reto Zihlmann
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
- Seminar for Statistics, ETH Zurich, Zurich, Switzerland
| | - Hugo Sax
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Aline Wolfensberger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zurich, Zurich, Switzerland
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Dunbar C, Santorelli JE, Marshall WA, Haines LN, Box K, Lee JG, Strait E, Costantini TW, Smith AM, Doucet JJ, Berndtson AE. Cross-Border Antibiotic Resistance Patterns in Burn Patients. Surg Infect (Larchmt) 2023; 24:327-334. [PMID: 37036781 DOI: 10.1089/sur.2022.313] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is a growing problem worldwide, with differences in regional resistance patterns partially driven by local variance in antibiotic stewardship. Trauma patients transferring from Mexico have more AMR than those injured in the United States; we hypothesized a similar pattern would be present for burn patients. Patients and Methods: The registry of an American Burn Association (ABA)-verified burn center was queried for all admissions for burn injury January 2015 through December 2019 with hospital length-of-stay (LOS) longer than seven days. Patients were divided into two groups based upon burn location: United States (USA) or Mexico (MEX). All bacterial infections were analyzed. Results: A total of 73 MEX and 826 USA patients were included. Patients had a similar mean age (40.4 years MEX vs. 42.2 USA) and gender distribution (69.6% male vs. 64.4%). The MEX patients had larger median percent total body surface area burned (%TBSA; 11.1% vs. 4.3%; p ≤ 0.001) and longer hospital LOS (18.0 vs. 13.0 days; p = 0.028). The MEX patients more often had respiratory infections (16.4% vs. 7.4%; p = 0.046), whereas rates of other infections were similar. The MEX patients had higher rates of any resistant organism (47.2% of organisms MEX vs. 28.1% USA; p = 0.013), and were more likely to have resistant infections on univariable analysis; however, on multivariable analysis country of burn was no longer significant. Conclusions: Antimicrobial resistance is more common in burn patients initially burned in Mexico than those burned in the United States, but location was not a predictor of resistance compared to other traditional burn-related factors. Continuing to monitor for AMR regardless of country of burn remains critical.
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Affiliation(s)
- Chance Dunbar
- School of Medicine, UC San Diego, San Diego, California, USA
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - William A Marshall
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Laura N Haines
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Kevin Box
- Department of Pharmacology, UC San Diego, San Diego, California, USA
| | - Jeanne G Lee
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Eli Strait
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Alan M Smith
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Jay J Doucet
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
| | - Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, UC San Diego, San Diego, California, USA
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Pradier L, Bedhomme S. Ecology, more than antibiotics consumption, is the major predictor for the global distribution of aminoglycoside-modifying enzymes. eLife 2023; 12:77015. [PMID: 36785930 PMCID: PMC9928423 DOI: 10.7554/elife.77015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/24/2023] [Indexed: 02/15/2023] Open
Abstract
Antibiotic consumption and its abuses have been historically and repeatedly pointed out as the major driver of antibiotic resistance emergence and propagation. However, several examples show that resistance may persist despite substantial reductions in antibiotic use, and that other factors are at stake. Here, we study the temporal, spatial, and ecological distribution patterns of aminoglycoside resistance, by screening more than 160,000 publicly available genomes for 27 clusters of genes encoding aminoglycoside-modifying enzymes (AME genes). We find that AME genes display a very ubiquitous pattern: about 25% of sequenced bacteria carry AME genes. These bacteria were sequenced from all the continents (except Antarctica) and terrestrial biomes, and belong to a wide number of phyla. By focusing on European countries between 1997 and 2018, we show that aminoglycoside consumption has little impact on the prevalence of AME-gene-carrying bacteria, whereas most variation in prevalence is observed among biomes. We further analyze the resemblance of resistome compositions across biomes: soil, wildlife, and human samples appear to be central to understand the exchanges of AME genes between different ecological contexts. Together, these results support the idea that interventional strategies based on reducing antibiotic use should be complemented by a stronger control of exchanges, especially between ecosystems.
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Affiliation(s)
- Léa Pradier
- CEFE, CNRS, Univ Montpellier, EPHE, IRD, Montpellier, France
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Moriyama Y, Doi A, Shinkai N, Nasu S, Mesaki K, Horii K, Ohmagari N, Hayakawa K. Clinical characteristics and risk factors for multidrug-resistant bacterial isolation in patients with international travel history. Am J Infect Control 2022; 51:660-667. [PMID: 36031036 DOI: 10.1016/j.ajic.2022.08.020] [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: 04/20/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND International travelers are at risk of carrying resistant bacteria. It is critical to identify risk factors associated with multidrug-resistant organism (MDRO) colonization in travelers. METHODS A retrospective chart review observational study was conducted at two tertiary centers in Japan for inpatients who had been hospitalized or visited an outpatient clinic overseas within the previous 12 months. These patients underwent MDRO screening upon admission. To identify independent predictors for the isolation of MDROs, multivariable analyses were performed using logistic regression. RESULTS In total, 76 (35%) of the 216 patients were positive for MDROs at admission. The majority of bacteria detected in stool samples were extended-spectrum beta-lactamase-producing Escherichia coli (ESBLEC) (n = 67 [89%]). ESBLEC was detected in nearly 40% of patients who traveled to Asia. Travel to Asia was an independent risk factor for any MDRO and ESBLEC isolation. For non-ESBLEC MDRO isolation, a history of surgery abroad was an independent risk factor for detection. DISCUSSION AND CONCLUSIONS A history of hospitalization abroad has previously been found to be associated with MDRO colonization in travelers, which was not identified as a risk factor in this study. The risk factors for MDRO colonization were different between ESBLEC and non-ESBL MDROs.
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Affiliation(s)
- Yuki Moriyama
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Noriko Shinkai
- Department of Infection Control, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Kazuhisa Mesaki
- Department of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kumi Horii
- Infection Control and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan.
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Berndtson AE. Increasing Globalization and the Movement of Antimicrobial Resistance between Countries. Surg Infect (Larchmt) 2020; 21:579-585. [PMID: 32434446 DOI: 10.1089/sur.2020.145] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The threat of antimicrobial resistance continues to grow worldwide, exacerbated by poor antibiotic stewardship practices, limited development of new antimicrobial agents, and increasing globalization. Methods: This review covers previously published studies examining how human movement contributes to the global spread of antimicrobial resistance, including between low- and middle-income and high-income countries. Results: The emergence of resistance in one country or part of the world can become a worldwide event quickly. Human movement, including travel, medical tourism, military service, and migration, results in the globalization of resistant bacterial strains. Conclusions: Increased surveillance, whole-genome sequencing, focused infection control, and effective stewardship practices are needed to maintain the efficacy of antibiotics.
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Affiliation(s)
- Allison E Berndtson
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, University of California-San Diego, San Diego, California, USA
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Meslé MMI, Hall IM, Christley RM, Leach S, Read JM. The use and reporting of airline passenger data for infectious disease modelling: a systematic review. Euro Surveill 2019; 24:1800216. [PMID: 31387671 PMCID: PMC6685100 DOI: 10.2807/1560-7917.es.2019.24.31.1800216] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 09/18/2018] [Indexed: 01/06/2023] Open
Abstract
BackgroundA variety of airline passenger data sources are used for modelling the international spread of infectious diseases. Questions exist regarding the suitability and validity of these sources.AimWe conducted a systematic review to identify the sources of airline passenger data used for these purposes and to assess validation of the data and reproducibility of the methodology.MethodsArticles matching our search criteria and describing a model of the international spread of human infectious disease, parameterised with airline passenger data, were identified. Information regarding type and source of airline passenger data used was collated and the studies' reproducibility assessed.ResultsWe identified 136 articles. The majority (n = 96) sourced data primarily used by the airline industry. Governmental data sources were used in 30 studies and data published by individual airports in four studies. Validation of passenger data was conducted in only seven studies. No study was found to be fully reproducible, although eight were partially reproducible.LimitationsBy limiting the articles to international spread, articles focussed on within-country transmission even if they used relevant data sources were excluded. Authors were not contacted to clarify their methods. Searches were limited to articles in PubMed, Web of Science and Scopus.ConclusionWe recommend greater efforts to assess validity and biases of airline passenger data used for modelling studies, particularly when model outputs are to inform national and international public health policies. We also recommend improving reporting standards and more detailed studies on biases in commercial and open-access data to assess their reproducibility.
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Affiliation(s)
- Margaux Marie Isabelle Meslé
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Ian Melvyn Hall
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- School of Mathematics, University of Manchester, Manchester, United Kingdom
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Emergency Preparedness and Response at Kings College London, London, United Kingdom
| | - Robert Matthew Christley
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Steve Leach
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Emergency Response Department, Public Health England, Salisbury, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Emergency Preparedness and Response at Kings College London, London, United Kingdom
- National Institute for Health Research, Health Protection Research Unit in Modelling Methodology at Imperial College London, London, United Kingdom
| | - Jonathan Michael Read
- National Institute for Health Research, Health Protection Research Unit in Emerging and Zoonotic Infections at University of Liverpool, Liverpool, United Kingdom
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Centre for Health Informatics Computation and Statistics, Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
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8
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Cross-border antibiotic resistance patterns in trauma patients. Surgery 2019; 166:109-115. [DOI: 10.1016/j.surg.2019.03.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/28/2019] [Accepted: 03/27/2019] [Indexed: 11/22/2022]
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Hue R, Coroller-Bec C, Guilloteau V, Libeau B, Birgand G. Highly drug-resistant bacteria: Is intra- and inter-hospital communication optimal? Med Mal Infect 2019; 49:447-455. [PMID: 30914214 DOI: 10.1016/j.medmal.2019.03.001] [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: 08/29/2018] [Revised: 12/04/2018] [Accepted: 03/04/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Communication represents a key component of the control of highly drug-resistant bacteria (HDRB) in healthcare settings. This survey assessed communication strategies developed and adopted in a large hospital network. METHODS An online survey was sent to 83 infection control specialists working in hospitals of the Pays de la Loire region, France, in June 2016. Internal and external systems of identification and communication of HDRB status (colonized and contact patients) were assessed at the following steps of the hospital pathway: patient admission, during the stay, at discharge, and at readmission. RESULTS Sixty-one hospitals (73%) participated in the survey: 31 (51%) had recently managed colonized patients and 51 (93%) had recently managed contact patients. At patient admission, 28 (46%) hospitals had an identification system for repatriated patients. During hospital stay, the colonized or contact status was informed in computerized patient records for 47/57 (82%) and 43 (75%) hospitals, respectively. At patient discharge, 56/61 (92%) hospitals declared transmitting the HDRB status to the downstream ward. Twenty-six and 25/60 (43% and 42%) hospitals had an automated alert system at readmission of colonized or contact patients, respectively. This strategy met the expectations of 15/61 (26%) infection control specialists. CONCLUSION Efforts are still required in terms of communication for HDRB control. Sharing experiences and tools developed by hospitals may be beneficial for the entire hospital network.
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Affiliation(s)
- R Hue
- Équipe opérationnelle d'hygiène, structure locale d'appui et d'expertise ECLIN, centre hospitalier Loire Vendée Océan, 85300 Challans, France
| | - C Coroller-Bec
- Équipe opérationnelle d'hygiène, structure locale d'appui et d'expertise LUTIN, centre hospitalier du Mans, 72037 Le Mans, France
| | - V Guilloteau
- Équipe opérationnelle d'hygiène, hôpital de la Corniche Angevine, 49290 Chalonnes, France
| | - B Libeau
- Équipe opérationnelle d'hygiène, structure locale d'appui et d'expertise COLINES, centre hospitalier de Saint-Nazaire, 44600 Saint-Nazaire, France
| | - G Birgand
- Centre d'appui à la prévention des infections associées aux soins des Pays de la Loire, CHU - Le Tourville, 5, rue Pr-Yves-Boquien, 44093 Nantes, France.; NIHR Health Protection Research Unit, Antimicrobial Resistance and Healthcare Associated Infection at Imperial College London, Hammersmith Campus, W12 0NN London, UK.
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Bonnet V, Dupont H, Glorion S, Aupée M, Kipnis E, Gérard JL, Hanouz JL, Fischer MO. Influence of bacterial resistance on mortality in intensive care units: a registry study from 2000 to 2013 (IICU Study). J Hosp Infect 2019; 102:317-324. [PMID: 30659869 DOI: 10.1016/j.jhin.2019.01.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/09/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Bacterial resistance to antibiotics is a daily concern in intensive care units. However, few data are available concerning the clinical consequences of in-vitro-defined resistance. AIM To compare the mortality of patients with nosocomial infections according to bacterial resistance profiles. METHODS The prospective surveillance registry in 29 French intensive care units (ICUs) participating during the years 2000-2013 was retrospectively analysed. All patients presenting with a nosocomial infection in ICU were included. FINDINGS The registry contained 88,000 eligible patients, including 10,001 patients with a nosocomial infection. Among them, 3092 (36.7%) were related to resistant micro-organisms. Gram-negative bacilli exhibited the highest rate of resistance compared to Gram-positive cocci (52.8% vs 48.1%; P < 0.001). In-hospital mortality was higher in cases of patients with antibiotic-resistant infectious agents (51.9% vs 45.5%; P < 0.001), and critical care length of stay was longer (33 ± 26 vs 29 ± 22 days; P < 0.001). These results remained significant after SAPS II matching (P < 0.001) and in the Gram-negative bacilli and Gram-positive cocci subgroups. No difference in mortality was found with respect to origin prior to admission. CONCLUSION Patients with bacterial resistance had higher ICU mortality and increased length of stay, regardless of the bacterial species or origin of the patient.
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Affiliation(s)
- V Bonnet
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France
| | - H Dupont
- Anaesthesiology and Critical Care Department, Amiens University Medical Center, Amiens, France; INSERM U 1088, University of Picardie Jules Verne, Centre Universitaire de Recherche en Santé, Amiens, France
| | - S Glorion
- Regional Coordinating Centre for Healthcare-Associated Infections Control (CClin Ouest), Rennes, France
| | - M Aupée
- Regional Coordinating Centre for Healthcare-Associated Infections Control (CClin Ouest), Rennes, France
| | - E Kipnis
- Department of Anaesthesiology and Critical Care - CHU Lille, Lille, France; Host-Pathogen Translational Research, EA 7366, University of Lille, Lille, France
| | - J L Gérard
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France
| | - J L Hanouz
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France
| | - M O Fischer
- Department of Anaesthesiology and Critical Care, University Hospital of Caen, Caen, France; Normandie Université, Esplanade de la Paix, CS 14 032, Caen, France.
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11
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N'Guyen TTH, Bourigault C, Guillet V, Buttes ACGD, Montassier E, Batard E, Birgand G, Lepelletier D. Association between excreta management and incidence of extended-spectrum β-lactamase-producing Enterobacteriaceae: role of healthcare workers' knowledge and practices. J Hosp Infect 2018; 102:31-36. [PMID: 30557588 DOI: 10.1016/j.jhin.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/10/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spread of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) in healthcare environments has become a major public health threat in recent years. AIM To assess how healthcare workers (HCWs) manage excreta and the possible association with the incidence of ESBL-PE. METHODS Eight hundred HCWs and 74 nurse-supervisors were questioned through two self-report questionnaires in order to assess their knowledge and practices, and to determine the equipment utilized for excreta management in 74 healthcare departments. Performance on equipment utilized, knowledge and practices were scored as good (score of 1), intermediate (score of 2) or poor (score of 3) on the basis of pre-established thresholds. Linear regression was performed to evaluate the association between HCWs' knowledge/practices and the incidence of ESBL-PE. FINDINGS Six hundred and eighty-eight HCWs (86%) and all nurse-supervisors participated in the survey. The proportions of respondents scoring 1, 2 and 3 were: 14.8%, 71.6% and 17.6% for equipment; 30.1%, 40.6 % and 29.3% for knowledge; and 2.0%, 71.9% and 26.1% for practices, respectively. The single regression mathematic model highlighted that poor practices (score of 3) among HCWs was significantly associated with increased incidence of ESBL-PE (P = 0.002). CONCLUSIONS A positive correlation was found between HCWs' practices for managing excreta and the incidence of ESBL-PE, especially in surgical units. There is an urgent need for development of public health efforts to enhance knowledge and practices of HCWs to better control the spread of multi-drug-resistant bacteria, and these should be integrated within infection control programmes.
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Affiliation(s)
| | - C Bourigault
- MiHAR Lab, University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - V Guillet
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - A-C Guille des Buttes
- Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France
| | - E Montassier
- MiHAR Lab, University of Nantes, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - E Batard
- MiHAR Lab, University of Nantes, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - G Birgand
- MiHAR Lab, University of Nantes, Nantes, France; Regional Infection Control Centre, Pays de la Loire, Nantes, France
| | - D Lepelletier
- MiHAR Lab, University of Nantes, Nantes, France; Bacteriology and Infection Control Department, Nantes University Hospital, Nantes, France.
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12
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Carriage of multi-drug resistant bacteria among foreigners seeking medical care. Sci Rep 2018; 8:9471. [PMID: 29930314 PMCID: PMC6013425 DOI: 10.1038/s41598-018-27908-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 05/23/2018] [Indexed: 11/12/2022] Open
Abstract
Medical tourism has a potential of spreading multi-drug resistant bacteria (MDR). The Hadassah Medical Center serves as a referral center for global medical tourists and for Palestinian Authority residents. In order to assess whether patients of these groups are more likely to harbor MDR bacteria than local residents, we reviewed data from all patients admitted to our institution between 2009 and 2014. We compared MDR rates between countries of residency, controlling for gender, age, previous hospitalization and time from admission to MDR detection. Overall, among 111,577 patients with at least one microbiological specimen taken during hospitalization, there were 3,985 (3.5%) patients with at least one MDR-positive culture. Compared to Israeli patients, tourists and patients from the Palestinian Authority had increased rates of MDR positivity (OR, 95%CI): 2.3 (1.6 to 2.3) and 8.0 (6.3 to 10.1), respectively. Our data show that foreign patients seeking advanced medical care are more likely to carry MDR bacteria than the resident population. Strategies to minimize MDR spread, such as pre-admission screening or pre-emptive isolation should be considered in this population.
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Segagni Lusignani L, Starzengruber P, Dosch V, Assadian O, Presterl E, Diab-Elschahawi M. Molecular epidemiology of multidrug-resistant clinical isolates of Acinetobacter baumannii : A 10-year analysis in a large tertiary care university hospital in central Europe with international admissions. Wien Klin Wochenschr 2017; 129:816-822. [PMID: 28776101 PMCID: PMC5676840 DOI: 10.1007/s00508-017-1242-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022]
Abstract
Background Over the last 10 years, multidrug resistant Acinetobacter baumannii has been spreading worldwide as emerging microorganisms that negatively impact on the outcome of in-hospital patients. Methods Between 2007 and 2016, all isolates of patients of the Vienna General Hospital (VGH), tested positive for multidrug resistant Acinetobacter baumannii (MDR A. baumannii) strains, were investigated with respect to their genetic relationship. Patient medical histories were reviewed in order to collect discriminating factors related to MDR A. baumannii colonization or infection. Results A total of 79 isolates of 76 patients were obtained. For 44 of them (55.7%) the first diagnosis ward was an intensive care unit (ICU). A total of 10 genotype clusters were identified and 35 cases (44.3%) of in-hospital acquisition in our institution could be detected. Multidrug resistant Acinetobacter baumannii isolates were acquired before admission to our hospital in 44 cases (55.7%) and in 31 (70.5%) they belonged to patients who had previous exposure to the healthcare setting of high prevalence countries for MDR A. baumannii. Conclusion Patients admitted to our hospital with a previous healthcare contact in a high prevalence country for multidrug resistant Acinetobacter baumannii should be screened before admission to high-risk wards. Isolation of these patients until microbiological results could reduce negative outcome in these wards.
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Affiliation(s)
- Luigi Segagni Lusignani
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter Starzengruber
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Verena Dosch
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ojan Assadian
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Petersen E, Mohsin J. Should travelers be screened for multi-drug resistant (MDR) bacteria after visiting high risk areas such as India? Travel Med Infect Dis 2016; 14:591-594. [PMID: 27913311 DOI: 10.1016/j.tmaid.2016.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 11/27/2016] [Indexed: 01/05/2023]
Affiliation(s)
- Eskild Petersen
- Department of Infectious Diseases, The Royal Hospital, Muscat, Oman; Institute of Clinical Medicine, University of Aarhus, Denmark.
| | - Jalila Mohsin
- Department of Clinical Microbiology, The Royal Hospital, Muscat, Oman
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Hayakawa K, Mezaki K, Sugiki Y, Nagamatsu M, Miyoshi-Akiyama T, Kirikae T, Kutsuna S, Takeshita N, Yamamoto K, Katanami Y, Ohmagari N. High rate of multidrug-resistant organism colonization among patients hospitalized overseas highlights the need for preemptive infection control. Am J Infect Control 2016; 44:e257-e259. [PMID: 27810070 DOI: 10.1016/j.ajic.2016.06.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 06/21/2016] [Accepted: 06/21/2016] [Indexed: 11/17/2022]
Abstract
We performed 4 years of active screening for multidrug resistant organism (MDRO) colonization among patients with a history of overseas hospitalization. Thirteen (56.5%) of 23 cases were positive for MDROs, which highlights the importance of preemptive infection control to prevent the spread of MDROs in this population.
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Affiliation(s)
- Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan.
| | - Kazuhisa Mezaki
- Department of Clinical Laboratory, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuko Sugiki
- Infection Control and Prevention, National Center for Global Health and Medicine, Tokyo, Japan
| | - Maki Nagamatsu
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Teruo Kirikae
- Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kei Yamamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yuichi Katanami
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Hassing RJ, Alsma J, Arcilla MS, van Genderen PJ, Stricker BH, Verbon A. International travel and acquisition of multidrug-resistant Enterobacteriaceae: a systematic review. ACTA ACUST UNITED AC 2016; 20:30074. [PMID: 26625301 DOI: 10.2807/1560-7917.es.2015.20.47.30074] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 09/23/2015] [Indexed: 12/18/2022]
Abstract
International travel is considered to be an important risk factor for acquisition of multidrug-resistant Enterobacteriaceae (MRE). The aim of this systematic review was to determine the effect of international travel on the risk of post-travel faecal carriage of MRE. Secondary outcomes were risk factors for acquisition of MRE. A systematic search for relevant literature in seven international databases was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles needed to report on (i) foreign travel, (ii) screening of asymptomatic participants, (iii) antimicrobial susceptibility data and (iv) faecal Enterobacteriaceae carriage. Two researchers independently screened the abstracts, assessed the full article texts for eligibility and selected or rejected them for inclusion in the systematic review. In case of disagreement, a third researcher decided on inclusion. Eleven studies were identified. In all studies, a high prevalence (>20%) of carriage of MRE after international travel was found. The highest prevalence was observed in travellers returning from southern Asia. Foreign travel was associated with an increased risk of carriage of MRE. Further research is needed to assess if this leads to an increase in the number of infections with MRE. Systematic review registration number: PROSPERO CRD42015024973.
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Affiliation(s)
- Robert Jan Hassing
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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17
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Delory T, Seringe E, Antoniotti G, Novakova I, Goulenok C, Paysant I, Boyer S, Carbonne A, Naas T, Astagneau P. Prolonged delay for controlling KPC-2-producing Klebsiella pneumoniae outbreak: the role of clinical management. Am J Infect Control 2015; 43:1070-5. [PMID: 26174583 DOI: 10.1016/j.ajic.2015.05.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) are becoming of immediate concern for infection control policies. Prompt detection of CPE on health care setting admission is crucial to halt the spread of an outbreak. We report a cluster of 13 Klebsiella pneumoniae carbapenemase (KPC)-2-producing K pneumoniae cases in a tertiary care hospital.The objective of this study was to identify contributing factors originating the outbreak. METHODS An outbreak investigation was conducted using descriptive epidemiology, observation of health care practices, and interviews of management staff. A root cause analysis was performed to identify patent and latent failures of infection control measures using the association of litigation and risk management method. RESULTS The main patent failure was the delay in identifying KPC-2-producing K pneumoniae carriers. Contributing factors were work and environmental factors: understaffing, lack of predefined protocols, staff members' characteristics, and underlying patients' characteristics. Latent failures were as follows: no promotion of the national guidelines for prevention of CPE transmission, no clear procedure for the management of patients hospitalized abroad, no clear initiative for promoting a culture of quality in the hospital, biologic activity recently outsourced to a private laboratory, and poor communication among hospital members. CONCLUSION Clinical management should be better promoted to control hospital outbreaks and should include team work and safety culture.
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Affiliation(s)
- T Delory
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France
| | - E Seringe
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France.
| | | | - I Novakova
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France
| | | | - I Paysant
- Groupe Générale de Santé, Paris, France
| | - S Boyer
- Groupe Générale de Santé, Paris, France; Laboratoire Bactériologie Novescia, Paris, France
| | - A Carbonne
- Office of Quality and Safety in Care, Direction Générale de l'Offre de Soins-Bureau PF2-Ministère de la Santé, des affaires sociales et du droit des femmes, Paris, France
| | - T Naas
- Department of Bacteriology, APHP, Laboratoire de Bactériologie-Virologie, Hôpital de Bicêtre, Le Kremlin Bicêtre, France; Centre National de Référence de la résistance aux antibiotiques, Le Kremlin Bicêtre, France; EA7361, Faculté de Médecine, Université Paris Sud, France
| | - P Astagneau
- Regional Centre for Nosocomial Infection Control, CClin Nord, Paris, France; Department of Epidemiology, Ecole des Hautes Etudes en Santé Publique/Universités Sorbonne Paris Cité, Paris, France
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Angue M, Allou N, Belmonte O, Lefort Y, Lugagne N, Vandroux D, Montravers P, Allyn J. Risk Factors for Colonization With Multidrug-Resistant Bacteria Among Patients Admitted to the Intensive Care Unit After Returning From Abroad. J Travel Med 2015; 22:300-5. [PMID: 26081076 DOI: 10.1111/jtm.12220] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Few national recommendations exist on management of patients returning from abroad and all focus on hospitalized patients. Our purpose was to compare, in an intensive care unit (ICU), the admission prevalence and acquisition of multidrug-resistant (MDR) bacteria carriage in patients with ("Abroad") or without ("Local") a recent stay abroad, and then identify the risk factors in "Abroad" patients. METHODS In this retrospective study, we reviewed charts of all the patients hospitalized in the ICU unit from January 2011 through July 2013 with hygiene samplings performed. We identified all patients who had stayed abroad ("Abroad") within 6 months prior to ICU admission. RESULTS Of 1,842 ICU patients, 129 (7%) "Abroad" patients were reported. In the "Abroad" group, the rate of MDR strain carriage was higher at admission (33% vs 6.7%, p < 0.001) and also more often diagnosed during the ICU stay (acquisition rate: 17% vs 5.2%, p < 0.001) than in "Local" patients. Risk factors associated with MDR bacteria carriage at admission in "Abroad" patients were diabetes mellitus [odds ratio (OR) 5.1 (1.7-14.8), p = 0.003] and "hospitalization abroad with antibiotic treatment" [OR 10.7 (4.2-27.3), p < 0.001]. Hospitalization abroad without antibiotic treatment was not identified as a risk factor. CONCLUSIONS The main factor associated with MDR bacteria carriage after a stay abroad seems to be a hospitalization abroad only in case of antibiotic treatment abroad. Screening and isolation of "Abroad" patients should be recommended, even in case of a first negative screening.
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Affiliation(s)
- Marion Angue
- Intensive Care Unit, CHU Félix Guyon, Saint-Denis, France
| | - Nicolas Allou
- Intensive Care Unit, CHU Félix Guyon, Saint-Denis, France
| | | | - Yannick Lefort
- Intensive Care Unit, CHU Félix Guyon, Saint-Denis, France
| | | | - David Vandroux
- Intensive Care Unit, CHU Félix Guyon, Saint-Denis, France
| | - Philippe Montravers
- Département Anesthésie Réanimation, AP-HP, Hop Bichat-Claude Bernard, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jérôme Allyn
- Intensive Care Unit, CHU Félix Guyon, Saint-Denis, France
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19
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Epelboin L, Robert J, Tsyrina-Kouyoumdjian E, Laouira S, Meyssonnier V, Caumes E. High Rate of Multidrug-Resistant Gram-Negative Bacilli Carriage and Infection in Hospitalized Returning Travelers: A Cross-Sectional Cohort Study. J Travel Med 2015; 22:292-9. [PMID: 25997830 DOI: 10.1111/jtm.12211] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Carriage of and infection with multidrug-resistant Gram-negative bacilli (MDR-GNB) are a potential cause of concern in travelers with no history of hospitalization abroad. METHODS All consecutive returning travelers hospitalized in our department between February 2012 and January 2013 were prospectively screened for MDR-GNB gastrointestinal tract carriage or infection. We compared the prevalence of MDR-GNB in travelers to a non-travelers nonexposed group. Then among the travelers, MDR-GNB carriers were compared to noncarriers to determine risk factors of acquisition of MDR-GNB. RESULTS Overall, 359 patients (191 travelers, 168 non-travelers) were included, and 25 (6.4%), including 23 travelers, harbored MDR-GNB. Five travelers had an MDR-GNB infection while 18 were asymptomatic enteric carriers. MDR-GNB carriage or infection was significantly more frequent in travelers (11.0% vs 1.2% for non-travelers, odds ratio (OR) = 11.3, p < 0.001) and in patients born outside France (OR = 1.67; p = 0.03). Among travelers, in multivariate analysis, factors independently associated with MDR-GNB carriage or infection were traveling to Asia (OR = 3.1; p = 0.01) and visiting friends and relatives (VFR) or migrants (OR=3.6; p = 0.01). CONCLUSIONS The 10-fold higher prevalence rate of MDR-GNB in travelers raises the issues of systematic screening of all travelers, and of the choice of first line antibiotic therapy when treating urinary tract infections in travelers, especially those VFR, migrants, and those returning from Asia.
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Affiliation(s)
- Loïc Epelboin
- Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.,Sorbonne Universités, UPMC Univ Paris, Paris, France
| | - Jérôme Robert
- Department of Bacteriology and Hygiene, Sorbonne Universités, Paris, France.,Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France.,INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
| | - Ellina Tsyrina-Kouyoumdjian
- Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Sonia Laouira
- INSERM, U1135, Centre d'Immunologie et des Maladies Infectieuses, CIMI, team E13 (Bacteriology), Paris, France
| | - Vanina Meyssonnier
- Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France
| | - Eric Caumes
- Infectious and Tropical Diseases Department, AP-HP, Hôpitaux Universitaires Pitié Salpêtrière - Charles Foix, Paris, France.,Sorbonne Universités, UPMC Univ Paris, Paris, France
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20
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Kaspar T, Schweiger A, Droz S, Marschall J. Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened? Antimicrob Resist Infect Control 2015. [PMID: 26213620 PMCID: PMC4514935 DOI: 10.1186/s13756-015-0071-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk. METHODS This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA). RESULTS A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p < 0.001), surgical procedure in a hospital abroad (p = 0.007), and - on admission to our hospital - active infection (p = 0.002), antibiotic treatment (p = 0.014) and presence of skin lesions (p = 0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization. CONCLUSION Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.
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Affiliation(s)
- T Kaspar
- Department of Infectious Diseases and Prevention, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - A Schweiger
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - S Droz
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - J Marschall
- Department of Infectious Diseases and Prevention, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Control of emerging extensively drug-resistant organisms (eXDRO) in France: a survey among infection preventionists from 286 healthcare facilities. Eur J Clin Microbiol Infect Dis 2015; 34:1615-20. [PMID: 25957988 DOI: 10.1007/s10096-015-2396-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/27/2015] [Indexed: 10/23/2022]
Abstract
We performed a multicenter survey in May-June 2012 to assess strategies in preventing the spread of emerging extensively drug-resistant organisms (eXDRO), including glycopeptide-resistant enterococci and carbapenemase-producing Enterobacteriaceae, in a convenient sample of French healthcare facilities (HCFs). The collected data included organization and measures to: (1) identify patients at risk for carrying eXDRO, (2) investigate and control sporadic cases or outbreaks, and (3) describe prior 2010-2012 episodes with one or more colonized patients. Of the 286 participating HCFs, 163 (57 %) and 134 (47 %) reported having a specific procedure to detect repatriates or patients hospitalized in foreign countries within the last year, respectively. Among the 97 HCFs with prior at-risk patient management experience, contact precautions, hospitalization in a single room, and screening for eXDRO carriage were quasi-systematically performed (n = 92/97, 95 %). The alleged time between admission and alert ranged from 24 to 48 h after the patient's admission; 203 (71 %) HCFs recommended obtaining three successive negative screening samples to declare a patient free of eXDRO colonization. During the last two years, 64 HCFs (23 %) had to manage at least one eXDRO case, with a total of 20 outbreaks with more than one secondary case. This first national survey shows that French HCFs were not totally ready to control eXDRO spread in 2012. Their previous experiences and capacities in controlling eXDRO outbreaks are quite heterogeneous from one hospital to another. Further researches are needed in order to understand the constraints in applying national guidance.
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Lepelletier D, Berthelot P, Lucet JC, Fournier S, Jarlier V, Grandbastien B. French recommendations for the prevention of 'emerging extensively drug-resistant bacteria' (eXDR) cross-transmission. J Hosp Infect 2015; 90:186-95. [PMID: 25986165 DOI: 10.1016/j.jhin.2015.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/07/2015] [Indexed: 11/15/2022]
Abstract
Controlling the spread of multi- or extensively drug-resistant bacteria (MDR or XDR) includes a dual strategy for reducing antibiotic prescriptions and preventing their spread from patient carriers. Standard precautions are applicable to all health professionals caring for any patients; additional barrier precautions (isolation) are recommended for patients carrying transmissible infectious diseases or MDR bacteria in sporadic or epidemic situations. Moreover, additional precautions may be required for populations at particular risk of infection or colonization by emerging XDR (eXDR), defined in our country as carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci. Our ability to detect and identify eXDR carriers early and ensure their follow-up, through effective communication between all those involved, is a significant challenge for controlling their spread. Thus, the French High Committee for Public Health has updated and standardized all French existing recommendations concerning the prevention of the cross-transmission of these bacteria, and these recommendations are summarized in this review. The recommendations are based on scientific and operational knowledge up to 2013. Different preventive strategies are recommended for patients found to be carrying eXDR and those who are considered to be at risk of having eXDR because of a history of contact. The local context, the experience of the infection control team, the different times at which detection of eXDR takes place (during admission, hospitalization, etc.) and the epidemiological situation (sporadic cases, clusters, outbreaks, widespread epidemic) must be included in risk assessments that in turn inform the control measures that should be applied in each clinical circumstance.
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Affiliation(s)
- D Lepelletier
- Unité de Gestion du risque Infectieux, Service de Bactériologie-Hygiène Hospitalière, CHU Nantes, Nantes, France; Université de Nantes, EA 3826, UFR Médecine, Nantes, France.
| | - P Berthelot
- Unité d'Hygiène Inter-Hospitalière, Service des Maladies Infectieuses et Laboratoire des Agents Infectieux et Hygiène, CHU St-Etienne, St Etienne, France
| | - J-C Lucet
- Unité Hospitalière de Lutte contre l'Infection Nosocomiale, GH Bichat - Claude Bernard, AP-HP, Paris, France
| | | | - V Jarlier
- Laboratoire de Bactériologie, Hôpital La Pitié-Salpêtrière, AP-HP, Paris, France; CLIN central de l'AP-HP, Paris, France
| | - B Grandbastien
- Unité de Lutte contre les Infections Nosocomiales, Service du Risque Infectieux, des Vigilances et d'Infectiologie, CHRU Lille, Lille, France
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Compain F, Decré D, Frazier I, Ramahefasolo A, Lavollay M, Carbonnelle E, Rostane H, Tackin A, Berger-Carbonne A, Podglajen I. Carbapenemase-producing bacteria in patients hospitalized abroad, France. Emerg Infect Dis 2015; 20:1246-8. [PMID: 24963645 PMCID: PMC4073856 DOI: 10.3201/eid2007.131638] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Millar MR. The Choice to Travel: Health Tourists and the Spread of Antibiotic Resistance. Public Health Ethics 2015. [DOI: 10.1093/phe/phv003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Girlich D, Nordmann P, Lécuyer H, Berche P, Marmorat-Khuong A, Gros I, Cuzon G, Dortet L. Multiple colonization with highly resistant bacteria: carbapenemase-producing Enterobacteriaceae, carbapenemase-producing Pseudomonas aeruginosa, carbapenemase-producing Acinetobacter baumannii, and glycopeptide-resistant Enterococcus faecium. Diagn Microbiol Infect Dis 2015; 81:217-8. [DOI: 10.1016/j.diagmicrobio.2014.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Revised: 11/18/2014] [Accepted: 12/09/2014] [Indexed: 11/29/2022]
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26
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Lepelletier D, Batard E, Berthelot P, Zahar JR, Lucet JC, Fournier S, Jarlier V, Grandbastien B. [Carbapenemase-producing enterobacteriae: epidemiology, strategies to control their spread and issues]. Rev Med Interne 2015; 36:474-9. [PMID: 25600328 DOI: 10.1016/j.revmed.2014.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
Abstract
The increasing bacterial resistance to antibiotics has become a major public health concern bringing the threat of therapeutic impasses. In this context, control of the spread of highly-resistant bacteria emerging antibiotics (BHRe), such as glycopeptide-resistant enterococci (VRE) and Enterobacteriaceae producing carbapenemases (CPE), is based on a dual strategy of reducing the prescription of antibiotics to limit the pressure selection and preventing the spread from carriers. Prevention strategy is based on three different levels such as standard precautions for all patients with a particular focus on the management of excreta, and additional precautions for BHRe carriers. What makes it difficult is that carriage is usually completely asymptomatic, enterobacteria and enterococci are normal commensal of gut microbiota. Explosive dissemination of Enterobacteriaceae producing extended spectrum beta-lactamases in hospital and community heralds the emergence of CPE whose import by patients with a history of hospitalization in abroad may be the main source of spread in France.
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Affiliation(s)
- D Lepelletier
- Unité de gestion du risque infectieux, université de Nantes, 6, rue du prof.-Yves-Boquien, 44093 Nantes cedex 01, France; EA3826, thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44035 Nantes, France.
| | - E Batard
- EA3826, thérapeutiques cliniques et expérimentales des infections, université de Nantes, 44035 Nantes, France
| | - P Berthelot
- Unité d'hygiène inter-hospitalière, service des maladies infectieuses et de microbiologie, CHU de Saint-Étienne, 42100 Saint-Étienne, France
| | - J-R Zahar
- Unité de lutte contre les infections nosocomiales, CHU d'Angers, 49100 Angers, France
| | - J-C Lucet
- Unité hospitalière de lutte contre l'infection nosocomiale, groupe hospitalier Bichat-Claude-Bernard, AP-HP, 75877 Paris, France
| | - S Fournier
- CLIN central de l'AP-HP, 75004 Paris, France
| | - V Jarlier
- CLIN central de l'AP-HP, 75004 Paris, France; Laboratoire de bactériologie, hôpital La Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - B Grandbastien
- Unité de lutte contre les infections nosocomiales, service de gestion du risque infectieux, des vigilances et d'infectiologie, CHRU de Lille, 59000 Lille, France
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Semin-Pelletier B, Cazet L, Bourigault C, Juvin ME, Boutoille D, Raffi F, Hourmant M, Blancho G, Agard C, Connault J, Corvec S, Caillon J, Batard E, Lepelletier D. Challenges of controlling a large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae in a French university hospital. J Hosp Infect 2015; 89:248-53. [PMID: 25601745 DOI: 10.1016/j.jhin.2014.11.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
Abstract
A large outbreak of OXA-48 carbapenemase-producing Klebsiella pneumoniae at Nantes University Hospital was investigated. The index case had no history of travel or hospitalization abroad and had been hospitalized in the internal medicine department for more than one month when the epidemic strain was isolated from a urine sample in June 2013. Seventy-two secondary cases were detected by weekly screening for gastrointestinal colonization during the two phases of the outbreak from June to October 2013 (33 cases) and from November 2013 to August 2014 (39 cases). Spread of the epidemic strain was attributed to the proximity of, and staff movement between, the infectious diseases (32 cases) and the internal medicine (26 cases) departments; 14 secondary cases were also observed in the renal transplant department following the transfer of an exposed patient from the infectious diseases department. Most of the patients (90%) were colonized and no death was linked to the epidemic strain. More than 3000 contact patients were reviewed and 6000 rectal swabs were performed. Initial control measures failed to control the outbreak owing to the late detection of the index case. The late implementation of three successive cohort units, the large number of transfers between wards, and the frequent readmission of cases contributed to the incomplete success of control measures.
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Affiliation(s)
- B Semin-Pelletier
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - L Cazet
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - C Bourigault
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - M E Juvin
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France
| | - D Boutoille
- Infectious Diseases Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France
| | - F Raffi
- Infectious Diseases Department, Nantes University Hospital, Nantes, France
| | - M Hourmant
- Renal Transplant Department, Nantes University Hospital, Nantes, France
| | - G Blancho
- Renal Transplant Department, Nantes University Hospital, Nantes, France
| | - C Agard
- Internal Medicine Department, Nantes University Hospital, Nantes, France
| | - J Connault
- Renal Transplant Department, Nantes University Hospital, Nantes, France
| | - S Corvec
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France
| | - J Caillon
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France
| | - E Batard
- University of Nantes, EA 3826, UFR Medicine School, Nantes, France; Emergency Department, Nantes University Hospital, Nantes, France
| | - D Lepelletier
- Bacteriology and Hygiene Department, Nantes University Hospital, Nantes, France; University of Nantes, EA 3826, UFR Medicine School, Nantes, France.
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Landelle C, Legrand P, Lesprit P, Cizeau F, Ducellier D, Gouot C, Bréhaut P, Soing-Altrach S, Girou E, Brun-Buisson C. Protracted Outbreak of Multidrug-ResistantAcinetobacter baumanniiafter Intercontinental Transfer of Colonized Patients. Infect Control Hosp Epidemiol 2015; 34:119-24. [DOI: 10.1086/669093] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To describe the course and management of a protracted outbreak after intercontinental transfer of 2 patients colonized with multidrug-resistantAcinetobacter baumannii(MDRAB).Design.An 18-month outbreak investigation.Setting.An 860-bed university hospital in France.Patients.Case patients (ie, carriers) were those colonized or infected with an MDRAB isolate.Methods.During the epidemic period, all intensive care unit (ICU) patients and contacts of carriers who were transferred to wards were screened for MDRAB carriage. Contact precautions, environmental screening, and auditing of healthcare worker (HCW) practices were implemented; rooms were cleaned with hydrogen peroxide mist disinfection. One ICU, in which most of the cases occurred, was closed on 4 occasions for thorough cleaning and disinfection.Results.The 2 index case patients were identified as 2 patients who carried the same MDRAB strain and who were admitted to the hospital after repatriation from Tahiti 5 months apart. During an 18-month period, a total of 84 secondary cases occurred. Reintroduction of MDRAB into the ICUs occurred from patients previously colonized or from healthcare personnel. Termination of the outbreak was only achieved when all carriers from wards or the ICU were cohorted to an isolation unit with dedicated healthcare personnel.Conclusions.Intercontinental transfer of carriers of MDRAB can result in extensive outbreaks and serious disruption of the hospital's organization. Transmission from carriers most likely occurred via the hands of HCWs, poor cleaning protocols, airborne spread, and contaminated water from sink traps. This protracted outbreak was controlled only after implementation of an extensive control program and eventual cohorting of all carriers in an isolation unit with dedicated healthcare personnel.
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Lübbert C, Straube L, Stein C, Makarewicz O, Schubert S, Mössner J, Pletz MW, Rodloff AC. Colonization with extended-spectrum beta-lactamase-producing and carbapenemase-producing Enterobacteriaceae in international travelers returning to Germany. Int J Med Microbiol 2015; 305:148-56. [DOI: 10.1016/j.ijmm.2014.12.001] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/01/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022] Open
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Bradai N, Scouarnec C, Chauvin V, Yelnik A. Klebsielle pneumoniae carbapenemase productive: About one epidemic. Ann Phys Rehabil Med 2014; 57:720-6. [DOI: 10.1016/j.rehab.2014.06.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 06/11/2014] [Accepted: 06/11/2014] [Indexed: 11/25/2022]
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Duchateau FX, Burnod A, Josseaume J. Évacuation sanitaire aérienne et rapatriement. MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0903-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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32
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Alfandari S, Gois J, Delannoy PY, Georges H, Boussekey N, Chiche A, Meybeck A, Patoz P, Blondiaux N, Senneville E, Melliez H, Leroy O. Management and control of a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. Med Mal Infect 2014; 44:229-31. [PMID: 24840286 DOI: 10.1016/j.medmal.2014.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 03/23/2014] [Accepted: 03/24/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We had for aim to describe the identification and management of a 14-clonal carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, following admission of a known CRAB-infected patient in an ICU. METHODS We reviewed the carriers' files and outbreak management procedures. RESULTS The index patient was admitted with strict isolation precautions. The outbreak started 2 months after his discharge. It persisted despite reinforcement of strict isolation precautions, staff and patient cohorting, and extensive environmental decontamination including 2 rounds of routine terminal cleaning and disinfection or 1 round of cleaning and disinfection followed by hydrogen peroxide treatment. A second epidemic peak, after 4 weeks without any case, led to another wide environmental sampling and decontamination rounds. The source of the CRAB outbreak was suspected to be the blood pressure cuffs Velcro. Switching to cuffs submersible in a disinfectant stopped the outbreak. CONCLUSIONS CRAB outbreaks are difficult to manage and sources of persistent colonization can be unexpected.
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Affiliation(s)
- S Alfandari
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France.
| | - J Gois
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - P-Y Delannoy
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - H Georges
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - N Boussekey
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - A Chiche
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - A Meybeck
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
| | - P Patoz
- Laboratoire de biologie, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - N Blondiaux
- Laboratoire de biologie, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - E Senneville
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - H Melliez
- Service universitaire des maladies infectieuses et du voyageur, centre hospitalier de Tourcoing, 59208 Tourcoing, France
| | - O Leroy
- Service de réanimation et des maladies infectieuses, centre hospitalier de Tourcoing, 155, rue du Président-Coty, 59208 Tourcoing cedex, France
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Fournier S, Monteil C, Lepainteur M, Richard C, Brun-Buisson C, Jarlier V, Ap-Hp Outbreaks Control Group C. Long-term control of carbapenemase-producing Enterobacteriaceae at the scale of a large French multihospital institution: a nine-year experience, France, 2004 to 2012. ACTA ACUST UNITED AC 2014; 19. [PMID: 24852956 DOI: 10.2807/1560-7917.es2014.19.19.20802] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In 2009, following the occurrence of several outbreaks of carbapenemase-producing Enterobacteriaceae (CPE), a programme for controlling the spread of CPE was implemented in the 38 hospitals of the Assistance Publique-Hôpitaux de Paris, a 21,000-bed institution. This programme included recommendations to isolate, and screen for CPE, patients previously hospitalised abroad, and bundled measures to control cross transmission (barrier precautions, dedicated staff and screening of contact patients). From 2004 to 2012, 140 CPE index cases were identified, 17 leading to outbreaks. After application of the programme, in spite of an increase in the number of CPE index cases epidemiologically linked with a recent stay or hospitalisation abroad, the proportion of cases followed by outbreaks, which was 40% (4/10) before 2009, decreased to 10% (13/130) (p=0.02), and the proportion of secondary cases among all CPE cases decreased from 69% (22/32) to 23% (38/168), (p<0.001). The number of secondary cases varied significantly depending on the speed and strength of the measures implemented around the CPE index case: quick (within two days of patient admission at the hospital) setting of nursing staff dedicated to the patient, quick setting of simple barrier precautions, or delayed measures of control (p=0.001). A sustained and coordinated strategy can lead to control CPE at the level of a large regional multi-hospital institution in a country where CPE are at an emerging stage.
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Affiliation(s)
- S Fournier
- Infection Control Team, Direction de la Politique Medicale, Assistance Publique-Hopitaux de Paris, Paris, France
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Mérens A, Rapp C, Delaune D, Danis J, Berger F, Michel R. Prevention of combat-related infections: antimicrobial therapy in battlefield and barrier measures in French military medical treatment facilities. Travel Med Infect Dis 2014; 12:318-29. [PMID: 24880793 DOI: 10.1016/j.tmaid.2014.04.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/16/2014] [Accepted: 04/07/2014] [Indexed: 12/12/2022]
Abstract
Infection is a major complication associated with combat-related injuries. Beside immobilization, wound irrigation, surgical debridement and delayed coverage, post-injury antimicrobials contribute to reduce combat-related infections, particularly those caused by bacteria of the early contamination flora. In modern warfare, bacteria involved in combat-related infections are mainly Gram-negative bacteria belonging to the late contamination flora. These bacteria are frequently resistant or multiresistant to antibiotics and spread through the deployed chain of care. This article exposes the principles of war wounds antimicrobial prophylaxis recommended in the French Armed Forces and highlights the need for high compliance to hygiene standard precautions, adapted contact precautions and judicious use of antibiotics in French deployed military medical treatment facilities (MTF).
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Affiliation(s)
- Audrey Mérens
- Biology Department and Infection Control Unit, Bégin Military Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France.
| | - Christophe Rapp
- Infectious Diseases Department, Bégin Military Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Deborah Delaune
- Biology Department and Infection Control Unit, Bégin Military Hospital, 69 avenue de Paris, 94160 Saint-Mandé, France
| | - Julien Danis
- Orthopaedic Surgery Department, Percy Military Hospital, 101 avenue Henri Barbusse, 92140 Clamart, France
| | - Franck Berger
- Epidemiology and Public Health Department CESPA, Camp de Sainte-Marthe, 408 rue Jean Queillau, 13014 Marseille, France
| | - Remy Michel
- Epidemiology and Public Health Department CESPA, Camp de Sainte-Marthe, 408 rue Jean Queillau, 13014 Marseille, France
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Janvier F, Delacour H, Tessé S, Larréché S, Sanmartin N, Ollat D, Rapp C, Mérens A. Faecal carriage of extended-spectrum β-lactamase-producing enterobacteria among soldiers at admission in a French military hospital after aeromedical evacuation from overseas. Eur J Clin Microbiol Infect Dis 2014; 33:1719-23. [PMID: 24807441 DOI: 10.1007/s10096-014-2141-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/24/2014] [Indexed: 11/28/2022]
Abstract
The aim of this study was to assess the faecal carriage of carbapenemase-producing enterobacteria (CPE) and extended-spectrum β-lactamase (ESBL)-producing enterobacteria among soldiers at admission in a French military hospital after aeromedical evacuation from overseas. During a period of 1 year, 83 rectal swabs collected in French soldiers at admission were screened for multidrug-resistant enterobacteria with a chromogenic medium. ESBL detection was performed with the double-disc synergy test in the absence or presence of cloxacillin. The genotypic characterisation of resistance mechanisms, sequence typing and phylotyping was performed by polymerase chain reaction (PCR) and sequencing with bacterial DNA extracted from isolates. No CPE was detected. Eleven ESBL Escherichia coli isolates belonging to four phylogenetic groups were detected, including ten CTX-M-15 and one CTX-M-14. The overall gut colonisation with ESBL-producing bacteria (13.25 %) was 6-fold higher than that reported in soldiers in the suburbs of Paris in 2009. ESBL faecal carriage was particularly high (34.48 %) in soldiers repatriated from Afghanistan (risk ratio = 18.62; p = 0.0001). This study highlights the importance of systematic additional contact precautions and CPE/ESBL screening in soldiers repatriated from overseas in French hospitals.
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Affiliation(s)
- F Janvier
- Service de Microbiologie et Hygiène hospitalière, Hôpital d'Instruction des Armées Bégin, Saint Mandé, France,
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Birgand G, Armand-Lefevre L, Lepainteur M, Lolom I, Neulier C, Reibel F, Yazdanpanah Y, Andremont A, Lucet JC. Introduction of highly resistant bacteria into a hospital via patients repatriated or recently hospitalized in a foreign country. Clin Microbiol Infect 2014; 20:O887-90. [PMID: 25069719 DOI: 10.1111/1469-0691.12604] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 01/12/2023]
Abstract
We describe the prevalence of carriage and variables associated with introduction of highly drug-resistant microorganisms (HDRMO) into a French hospital via patients repatriated or recently hospitalized in a foreign country. The prevalence of HDRMO was 11% (15/132), with nine carbapenamase-producing Enterobacteriaceae, nine carbapenem-resistant Acinetobacter baumannii and six glycopeptide-resistant enterococci. Half of the admitted patients (63/132, 48%) were colonized with extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE). Among the four episodes with secondary cases, three involved A. baumannii.
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Affiliation(s)
- G Birgand
- AP-HP, Infection Control Unit, Hôpital Bichat - Claude Bernard, Paris, France; IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
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Investigation and management of multidrug-resistant Acinetobacter baumannii spread in a French medical intensive care unit: one outbreak may hide another. Am J Infect Control 2013; 41:652-3. [PMID: 23266385 DOI: 10.1016/j.ajic.2012.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 11/21/2022]
Abstract
An outbreak in a medical intensive care unit was due to an OXA-23-producing Acinetobacter baumannii strain imported from a repatriate hospitalized in Singapore. This outbreak revealed another multidrug resistant epidemic strain that had been present in the hospital for 2 years. Both outbreaks were controlled after 9 months of an extensive infection control program.
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38
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Gastmeier P. Problemkeime. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00398-012-0975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Josseaume J, Verner L, Brady WJ, Duchateau FX. Multidrug-resistant bacteria among patients treated in foreign hospitals: management considerations during medical repatriation. J Travel Med 2013; 20:22-8. [PMID: 23279227 DOI: 10.1111/j.1708-8305.2012.00668.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 09/18/2012] [Accepted: 09/21/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND The repatriation of patients from foreign hospitals can foster the emergence and spread of multidrug-resistant bacteria (MRB). We aimed to evaluate the incidence of MRB in patients treated in foreign hospitals and repatriated by international inter-hospital air transport in order to better manage these patients and adjust our procedures. METHODS The records from all consecutive aeromedical evacuations and overseas repatriations carried out by Mondial Assistance France between December 2010 and November 2011 were reviewed for this study. Only inter-hospital transfers with inpatient destination of an acute care unit were considered. Patients were allocated to one of two groups: those identified as MRB carriers at their arrival in France and those who were not identified as such (either negative for MRB or not tested). Data were compared between the two groups. RESULTS Analysis was performed on 223 patients: 16 patients (7%) were identified as MRB carriers. Compared with confirmed non-MRB patients, MRB carriers came more frequently from a high-risk unit (88% vs 59%, p = 0.05) and had a longer foreign hospital stay [13 (3-20) vs 8 (6-14) d, p = 0.01]. CONCLUSIONS The occurrence of MRB among patients repatriated from foreign hospitals is noted in a significant minority of such individuals transferred back to their home country. The typical MRB patient was admitted to a high-risk unit in a foreign hospital prior to repatriation with longer foreign hospital admissions. The prospective identification of these patients prior to transport is difficult. While these factors are associated with MRB presence, their absence does not rule out highly resistant bacterial colonization. A systematic review of this important medical issue is warranted with the development of guidelines.
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40
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Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce? J Antimicrob Chemother 2012. [DOI: 10.1093/jac/dks469] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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41
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Infection urinaire à Escherichia coli producteur de β-lactamase à spectre étendu chez un voyageur au retour d’Asie du Sud-Est. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13149-012-0268-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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42
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Fournier S, Lepainteur M, Kassis-Chikhani N, Huang M, Brun-Buisson C, Jarlier V. Link between carbapenemase-producing Enterobacteria carriage and cross-border exchanges: eight-year surveillance in a large French multihospitals institution. J Travel Med 2012; 19:320-3. [PMID: 22943275 DOI: 10.1111/j.1708-8305.2012.00641.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 06/06/2012] [Accepted: 06/11/2012] [Indexed: 11/28/2022]
Abstract
Assistance Publique-Hôpitaux de Paris launched a specific strategy to survey and control the spread of emerging multidrug-resistant bacteria such as carbapenemase-producing Enterobacteria (CPE). Among the 63 CPE events that occurred between 2004 and 2011, 87% involved patients with a link with cross-border exchanges, justifying the recommendation to screen and isolate such patients.
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Affiliation(s)
- Sandra Fournier
- Central Infection Control Team, Assistance Publique-Hôpitaux de Paris, Paris, France.
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Nordmann P, Gniadkowski M, Giske CG, Poirel L, Woodford N, Miriagou V. Identification and screening of carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect 2012; 18:432-8. [PMID: 22507110 DOI: 10.1111/j.1469-0691.2012.03815.x] [Citation(s) in RCA: 276] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Carbapenem-hydrolysing β-lactamases are the most powerful β-lactamases, being able to hydrolyse almost all β-lactams. They are mostly of the KPC, VIM, IMP, NDM and OXA-48 types. Their current extensive spread worldwide in Enterobacteriaceae is an important source of concern, as these carbapenemase producers are multidrug-resistant. Detection of infected patients and of carriers are the two main approaches for prevention of their spread. Phenotypic and molecular-based techniques are able to identify these carbapenemase producers, although with variable efficiencies. The detection of carriers still relies mostly on the use of screening culture media.
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Affiliation(s)
- P Nordmann
- Service de Bactériologie-Virologie, INSERM U914 'Emerging Resistance to Antibiotics', Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine et Université Paris-Sud, K.-Bicêtre, France.
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Denis C, Poirel L, Carricajo A, Grattard F, Fascia P, Verhoeven P, Gay P, Nuti C, Nordmann P, Pozzetto B, Berthelot P. Nosocomial transmission of NDM-1-producing Escherichia coli within a non-endemic area in France. Clin Microbiol Infect 2012; 18:E128-30. [DOI: 10.1111/j.1469-0691.2012.03761.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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