No nosocomial transmission under standard hygiene precautions in short term contact patients in case of an unexpected ESBL or Q&A E. coli positive patient: a one-year prospective cohort study within three regional hospitals
Tóm tắt
Many Highly Resistant Gram Negative Rod (HR-GNR) positive patients are found unexpectedly in clinical cultures, besides patients who are screened and isolated based on risk factors. As unexpected HR-GNR positive patients are isolated after detection, transmission to contact patients possibly occurred. The added value of routine contact tracing in such situations within hospitals with standard hygiene precautions is unknown. In 2014, this study was performed as a prospective cohort study. Index patients were defined as those tested unexpectedly HR-GNR positive in clinical cultures to diagnose a possible infection and were nursed under standard hygiene precautions before tested positive. After detection they were nursed in contact isolation. Contact patients were still hospitalized and shared the same room with the index patient for at least 12 h. HR-GNR screening was performed by culturing a rectal and throat swab. Clonal relatedness of HR-GNR isolates was determined using whole genome sequencing (WGS). Out of 152 unexpected HR-GNR positive patients, 35 patients (23.0%) met our inclusion criteria for index patient. ESBL E. coli was found most frequently (n = 20, 57.1%), followed by Q&A E. coli (n = 10, 28.6%), ESBL K. pneumoniae (n = 3, 8.5%), ESBL R. ornithinolytica (n = 1, 2.9%) and multi resistant P. aeruginosa (n = 1, 2.9%). After contact tracing, 69 patients were identified as contact patient of an index patient, with a median time between start of contact and sampling of 3 days. None were found HR-GNR positive by nosocomial transmission. In a local setting within hospitals with standard hygiene precautions, routine contact tracing among unexpected HR-GNR positive patients may be replaced by appropriate surveillance as we found no nosocomial transmission in short term contacts.
Tài liệu tham khảo
Rottier WC, Ammerlaan HS, Bonten MJ. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum β-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother. 2011;67(6):1311–20.
Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(2):S82–9.
Filice GA, Nyman JA, Lexau C, Lees CH, Bockstedt LA, Como-Sabetti K, et al. Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol. 2010;31(4):365–73.
Cosgrove SE, Kaye KS, Eliopoulous GM, Carmeli Y. Health and economic outcomes of the emergence of third-generation cephalosporin resistance in Enterobacter species. Arch Intern Med. 2002;162(2):185–90.
Reuland EA, Al Naiemi N, Kaiser AM, Heck M, Kluytmans JA, Savelkoul PH, et al. Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam. J Antimicrob Chemother. 2016;71(4):1076–82.
Willemsen I, Oome S, Verhulst C, Pettersson A, Verduin K, Kluytmans J. Trends in Extended Spectrum Beta-Lactamase (ESBL) Producing Enterobacteriaceae and ESBL Genes in a Dutch Teaching Hospital, Measured in 5 Yearly Point Prevalence Surveys (2010-2014). PLoS One. 2015;10(11):e0141765.
Kahvecioglu D, Ramiah K, McMaughan D, Garfinkel S, McSorley VE, Nguyen QN, et al. Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings, October 1, 2010-December 31, 2011. Infect Control Hosp Epidemiol. 2014;35(Suppl 3):S48–55.
Reuland EA, Overdevest IT, Al Naiemi N, Kalpoe JS, Rijnsburger MC, Raadsen SA, et al. High prevalence of ESBL-producing Enterobacteriaceae carriage in Dutch community patients with gastrointestinal complaints. Clin Microbiol Infect. 2012;19(6):542–9.
Balkhair A, Al-Farsi YM, Al-Muharrmi Z, Al-Rashdi R, Al-Jabri M, Neilson F, et al. Epidemiology of multi-drug resistant organisms in a teaching hospital in oman: a one-year hospital-based study. Sci World J. 2014;2014:157102.
Eilers R, Veldman-Ariesen MJ, Haenen A, van Benthem BH. Prevalence and determinants associated with healthcare-associated infections in long-term care facilities (HALT) in the Netherlands, May to June 2010. Euro Surveill. 2012;17(34). https://www.ncbi.nlm.nih.gov/pubmed/22939212.
Hopmans T, Smid EA, Wille JC, de Greeff SC. Healthcare-associated infections on readmission: 1 in 3 is linked to previous hospital admission. Ned Tijdschr Geneeskd. 2015;159:A8404.
van der Kooi TI, Manniën J, Wille JC, van Benthem BH. Prevalence of nosocomial infections in The Netherlands, 2007-2008: results of the first four national studies. J Hosp Infect. 2010;75(3):168–72.
Ider BE, Clements A, Adams J, Whitby M, Muugolog T. Prevalence of hospital-acquired infections and antibiotic use in two tertiary Mongolian hospitals. J Hosp Infect. 2010;75(3):214–9.
Paltansing S, Vlot JA, Kraakman ME, Mesman R, Bruijning ML, Bernards AT, et al. Extended-spectrum β-lactamase-producing enterobacteriaceae among travelers from the Netherlands. Emerg Infect Dis. 2013;19(8):1206–13.
von Wintersdorff CJ, Penders J, Stobberingh EE, Oude Lashof AM, Hoebe CJ, Savelkoul PH, et al. High rates of antimicrobial drug resistance gene acquisition after international travel, The Netherlands. Emerg Infect Dis. 2014;20(4):649–57.
Arcilla MS, van Hattem JM, Haverkate MR, Bootsma MC, van Genderen PJ, Goorhuis A, et al. Import and spread of extended-spectrum β-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study. Lancet Infect Dis. 2017;17(1):78–85.
Bijzonder resistente micro-organismen (BRMO). Werkgroep Infectie Preventie (WIP). 2012. http://www.rivm.nl/dsresource?objectid=b6b99580-44e2-4b9c-8183-52871e61764f&type=org&disposition=inline. Accessed 25 Oct 2016.
Willemsen I, Elberts S, Verhulst C, Rijnsburger M, Filius M, Savelkoul P, et al. Highly Resistant Gram-Negative Microorganisms: Incidence Density and Occurrence of Nosocomial Transmission (TRIANGLe Study). Infect Control Hosp Epidemiol. 2011;32(4):333–41.
Tschudin-Sutter S, Frei R, Dangel M, Stranden A, Widmer AF. Rate of transmission of extended-spectrum beta-lactamase-producing enterobacteriaceae without contact isolation. Clin Infect Dis. 2012;55(11):1505–11.
Werkgroep Infectie Preventie. Meticilline-resistente Staphylococcus aureus. WIP. 2012. Available: http://www.rivm.nl/dsresource?objectid=3f054354-ff4a-43ef-91f9-7c6f0417be95&type=org&disposition=inline. Accessed 25 Oct 2016.
World Health Organization. Five moments for hand hygiene. WHO. 2009. Available: http://www.who.int/gpsc/tools/Five_moments/en/. Accessed 14 Mar 2017.
Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Biddle JW, Steward CD, et al. Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 2001;45:1151–61.
Lauretti L, Riccio ML, Mazzariol A, Cornaglia G, Amicosante G, Fontana R, et al. Cloning and characterization of blaVIM, a new integron-borne metallo-beta-lactamase gene from a Pseudomonas aeruginosa clinical isolate. Antimicrob Agents Chemother. 1999;43:1584–90.
Swayne RL, Ludlam HA, Shet VG, Woodford N, Curran MD. Real-time TaqMan PCR for rapid detection of genes encoding five types of non-metallo- (class A and D) carbapenemases in Enterobacteriaceae. Int J Antimicrob Agents. 2011;38:35-38.
Kluytmans-van den Bergh MF, Rossen JW, Bruijning-Verhagen PC, Bonten MJ, Friedrich AW, Vandenbroucke-Grauls CM, et al. Whole genome multilocus sequence typing of extended-spectrum beta-lactamase-producing Enterobacteriaceae. J Clin Microbiol. 2016;4(12):2919–27.
Wilson EB. Probable inference, the law of succession, and statistical inference. J Am Stat Assoc. 1927;22:209–12.
Souverein D, Euser SM, Herpers BL, Diederen B, Houtman P, van Seventer M, et al. Prevalence, risk factors and molecular epidemiology of highly resistant gram negative rods in hospitalized patients in the Dutch region Kennemerland. Antimicrob Resist Infect Control. 2016;5:8.
Alves M, Lemire A, Decré D, Margetis D, Bigé N, Pichereau C, et al. Extended-spectrum beta-lactamase--producing enterobacteriaceae in the intensive care unit: acquisition does not mean cross-transmission. BMC Infect Dis. 2016;16:147.
Voor In 't Holt AF, Wattel AA, Boers SA, Jansen R, Hays JP, Goessens WH, et al. Detection of Healthcare-Related Extended-Spectrum Beta-Lactamase-Producing Escherichia coli Transmission Events Using Combined Genetic and Phenotypic Epidemiology. PLoS One. 2016;11(7):e0160156.
Mellmann A, Bletz S, Böking T, Kipp F, Becker K, Schultes A, et al. Real-Time Genome Sequencing of Resistant Bacteria Provides Precision Infection Control in an Institutional Setting. J Clin Microbiol. 2016;54(12):2874–81.
Rogers BA, Sidjabat HE, Paterson DL. Escherichia coli O25b-ST131: a pandemic, multiresistant, community-associated strain. J Antimicrob Chemother. 2011;66(1):1–14.
Kitchel B, Rasheed JK, Patel JB, Srinivasan A, Navon-Venezia S, Carmeli Y, et al. Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258. Antimicrob Agents Chemother. 2009;53(8):3365–70.
Dautzenberg MJ, Haverkate MR, Bonten MJ, Bootsma MC. Epidemic potential of Escherichia coli ST131 and Klebsiella pneumoniae ST258: a systematic review and meta-analysis. BMJ Open. 2016;6(3):e009971.
Ligduurmonitor Nederlandse ziekenhuizen 2012. COPPA. 2013. http://www.coppa.nl/wp-content/uploads/2014/01/Coppa-Ligduurmonitor-2012.pdf. Accessed 25 Oct 2016.
D’Agata EM, Gautam S, Green WK, Tang YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis. 2002;34(2):167–72.