Thomas Obadia1, Lulla Opatowski2, Laura Temime3, Jean-Louis Herrmann4, Éric Fleury5, Pierre-Yves Boëlle1, Didier Guillemot2. 1. 1Sorbonne Universités,UPMC Univ Paris 06,UMR_S 1136,Institut Pierre Louis d'Epidémiologie et de Santé Publique,F-75013,Paris,France. 2. 3INSERM,UMR 1181 "Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases" (B2PHI),F-75015 Paris,France. 3. 6Laboratoire MESuRS,Conservatoire National des Arts et Métiers,75003,Paris,France. 4. 7INSERM,U1173,UFR Simone Veil,Versailles-Saint-Quentin University,78180 Saint-Quentin en Yvelines,France. 5. 9ENS de Lyon,Université de Lyon,Laboratoire de l'Informatique du Parallélisme (UMR CNRS 5668-ENS de Lyon-UCB Lyon 1),IXXI Rhône Alpes Complex Systems Institute,France.
Abstract
BACKGROUND: Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination. OBJECTIVE: To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination. DESIGN Nested case-control study. SETTING: French long-term care facility in 2009. PARTICIPANTS: Patients (n=329) and HCWs (n=261). METHODS: We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables. RESULTS: The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage. CONCLUSIONS: Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.
BACKGROUND: Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination. OBJECTIVE: To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination. DESIGN Nested case-control study. SETTING: French long-term care facility in 2009. PARTICIPANTS: Patients (n=329) and HCWs (n=261). METHODS: We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables. RESULTS: The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage. CONCLUSIONS: Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.
Authors: David R M Smith; Audrey Duval; Koen B Pouwels; Didier Guillemot; Jérôme Fernandes; Bich-Tram Huynh; Laura Temime; Lulla Opatowski Journal: BMC Med Date: 2020-12-08 Impact factor: 8.775