C Legeay1, V Thépot-Seegers2, H Pailhoriès3, D Hilliquin4, J-R Zahar5. 1. Infection Control and Prevention Unit, CHU d'Angers, University of Angers, Angers, France. Electronic address: clement.pharma@gmail.com. 2. Data Management Research Department DRCI, Angers Hospital and SFR ICAT, University of Angers, Angers, France. 3. Center for Research in Cancerology & Immunology Nantes-Angers, Institut National de la Santé et de la Recherche Médicale, Université de Nantes, Université d'Angers, Angers, France; Laboratoire de Bactériologie, IRIS, CHU d'Angers, Angers, France. 4. Infection Control and Prevention Unit, CHU d'Angers, University of Angers, Angers, France. 5. Département de Microbiologie Clinique et Unité de Contrôle et de Prévention du risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, Bobigny, France; IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, France.
Abstract
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are a major health issue. Cohorting may help to control spread of CPEs in hospitals, but is expensive and hard to implement. AIM: To identify ward variables associated with CPE in-hospital transmission in a hospital where cohorting has never been implemented. METHODS: Cohort prospective study, comparing 14-consecutive-day periods regarding in-hospital transmission. Each period met the two following conditions: (i) CPE carriers/infected admitted for ≥48 h; (ii) 80% of relative contact patients were screened at least twice. Periods (a) with no acquired CPE case among relative contact patients were compared to periods (b) during which one or more CPE case acquisition was identified. Variables potentially associated with CPE transmission were assessed: colonization pressure, caregiver:patient ratio, hand hygiene compliance, hydro-alcoholic product consumption, antibiotic consumption, and infection control team (ICT) involvement on the ward. FINDINGS: Sixty-eight periods of two consecutive weeks were included, 18 (26.5%) included at least one CPE case acquisition. By multivariate analysis, colonization pressure (odds ratio: 1.12; 95% confidence interval: 1.0-1.25; P = 0.042) and antibiotic consumption (2.41; 1.02-5.66; P = 0.044) were associated with CPE in-hospital transmission. Caregiver:patient ratio potentiated both these variables, suggesting a role for understaffing in CPE transmission. CONCLUSION: Understanding ward variables associated with CPE spread can help design suitable solutions. Colonization pressure and antibiotic consumption seems to be driving in-hospital transmission, along with caregiver:patient ratio. In presence of high colonization pressure, dedicated healthcare workers for managing CPE patients should be implemented. Co-ordination between ICT and antimicrobial stewardship team is also crucial to prevent CPE spread.
BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are a major health issue. Cohorting may help to control spread of CPEs in hospitals, but is expensive and hard to implement. AIM: To identify ward variables associated with CPE in-hospital transmission in a hospital where cohorting has never been implemented. METHODS: Cohort prospective study, comparing 14-consecutive-day periods regarding in-hospital transmission. Each period met the two following conditions: (i) CPE carriers/infected admitted for ≥48 h; (ii) 80% of relative contact patients were screened at least twice. Periods (a) with no acquired CPE case among relative contact patients were compared to periods (b) during which one or more CPE case acquisition was identified. Variables potentially associated with CPE transmission were assessed: colonization pressure, caregiver:patient ratio, hand hygiene compliance, hydro-alcoholic product consumption, antibiotic consumption, and infection control team (ICT) involvement on the ward. FINDINGS: Sixty-eight periods of two consecutive weeks were included, 18 (26.5%) included at least one CPE case acquisition. By multivariate analysis, colonization pressure (odds ratio: 1.12; 95% confidence interval: 1.0-1.25; P = 0.042) and antibiotic consumption (2.41; 1.02-5.66; P = 0.044) were associated with CPE in-hospital transmission. Caregiver:patient ratio potentiated both these variables, suggesting a role for understaffing in CPE transmission. CONCLUSION: Understanding ward variables associated with CPE spread can help design suitable solutions. Colonization pressure and antibiotic consumption seems to be driving in-hospital transmission, along with caregiver:patient ratio. In presence of high colonization pressure, dedicated healthcare workers for managing CPE patients should be implemented. Co-ordination between ICT and antimicrobial stewardship team is also crucial to prevent CPE spread.
Authors: Abigail Collingwood; Freida Blostein; Anna M Seekatz; Christiane E Wobus; Robert J Woods; Betsy Foxman; Michael A Bachman Journal: Open Forum Infect Dis Date: 2020-01-12 Impact factor: 3.835
Authors: Eric Farfour; Marion Lecuru; Laurent Dortet; Morgan Le Guen; Charles Cerf; Françoise Karnycheff; Rémy A Bonnin; Marc Vasse; Philippe Lesprit Journal: Am J Infect Control Date: 2020-10-02 Impact factor: 2.918