Assessment of Multidrug-Resistant Organism and Viral Pathogen Transmission From the Rooms of Hospitalized Patients to Healthcare Workers and the Hospital Environment Utilizing Surrogate Markers

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug resistant organism (MDRO) frequently involved in skin, soft tissue and bone infections. Moreover, it is one of the most frequently isolated pathogen in bloodstream infections in European countries. Because of its capacity to survive on inanimate surfaces, this microorganism could be detected not only on hospital environment, but also in other healthcare settings such as ambulances. We performed a systematic review in order to study the level of MRSA contamination in ambulances (vehicle surfaces and medical equipment). Methods In March 2019 we searched studies in PubMed using the key search terms “MRSA, ambulance”. We included different designs of studies in English. Results The research yielded 18 publications: after title, abstract and full text’s analysis, 9 manuscripts were included in this review. Studies were conducted from 2007 to 2018 in USA, Egypt, Poland, Germany and South Korea. Overall, the number of ambulances sampled for MRSA was 511 (min. 3-max. 150), and 64 (12.5%) resulted contaminated by MRSA. Sampling points examined for each vehicle varied from 5 to 33, for a total of 5872 (min. 39-max. 2136) samplings performed. The amount of MRSA positive samplings was 145/5872 (2.5%) (min. 1-max. 43). Stretcher resulted the most frequently contaminated fomite (29 of the 145 MRSA positive samplings, 20%). Conclusions Despite MRSA prevalence is decreasing in Europe, recent studies showed how this MDRO could still be responsible of a remarkable burden in terms of attributable deaths and costs. Implementing effective sanitation procedures with a continuative monitoring of the processes is highly recommended in all the healthcare settings, including ambulances. Automated terminal disinfection of these vehicles, adopting technologies such as ultraviolet germicidal irradiation or hydrogen peroxide aerosol, could reduce bacterial contamination hosted on surfaces and medical equipment. Key messages Although the percentage of isolates of MRSA in European countries is decreasing, the burden this multidrug resistant organism in terms of mortality and costs remains remarkable. Ambulances must be considered as a potential reservoir of MRSA because of its ability to survive on inanimate surfaces, and adequate sanitation procedures should be frequently performed.

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Multidrug-resistant Gram-negative bacteria from patients, hospital environment and healthcare workers: a six-month cross-sectional study

10.1101/425330 ◽

2018 ◽

Cited By ~ 1

Author(s):

Aline F. R. Sereia ◽

Patricia A. da Cunha ◽

Daniela C. Tartari ◽

Caetana P. Zamparette ◽

Diana A. Estigarribia ◽

...

Keyword(s):

Healthcare Workers ◽

Screening Program ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Hospital Environment ◽

Surveillance Program ◽

Gram Negative Bacteria ◽

Cross Sectional ◽

Gram Negative ◽

Hospital Units

AbstractHealthcare-associated infections (HAI) are an important public health threat with the multidrug-resistant (MDR) gram-negative bacteria (GNB) being of particular concern. Here we present the antimicrobial resistance profile of HAI-related GNB (HAIrB) isolated from patients (PT), healthcare workers (HCW) and hospital environment (HE) in a six-month screening program. From the 180 sampling points distributed in six hospital units, a total of 1,080 swabs were collected allowing the isolation of 390 HAIrB: 50.5% from HE, 42.6% from PT and 6.9% from HCW. Among the HAIrB, 32.6% were characterized as MDR and 38.7% as extended-spectrum cephalosporins resistant (ESC-R), showing no differences in the distribution between PT, HE and HCW. Carbapenem resistance (CARB-R) was detected for 17.7% of all HAIrB, being higher among Acinetobacter spp. isolates (36.5%), followed by Enterobacteriaceae (14.5%) and Pseudomonas spp. (11.8%). Except for the ICU, that revealed higher MDR, CARB-R and ESC-R rates, HAIrB-resistant profiles were similarly detected within the hospital units. Prevalence of blaKPC-like and blaCTX-M-1 β-lactamases-resistance genes was higher in K. pneumoniae and E. cloacae complex, while blaOXA-23-like and blaSPM-like were higher in A. baumannii and P. aeruginosa, respectively. This study reveals that the spreading of HAIrB within a hospital environment is higher than predicted, indicating that healthcare workers, hospital areas and equipment are key players on dissemination of MDR gram-negative bacteria and shows that an active surveillance program can provide precise understanding and direct actions towards control of HAI.

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Assessment of antibiotic-resistant organism transmission among rooms of hospitalized patients, healthcare personnel, and the hospital environment utilizing surrogate markers and selective bacterial cultures

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.376 ◽

2020 ◽

Vol 41 (5) ◽

pp. 539-546

Author(s):

Jennie H. Kwon ◽

Kimberly Reske ◽

Caroline A. O’Neil ◽

Candice Cass ◽

Sondra Seiler ◽

...

Keyword(s):

Academic Medical Center ◽

Tertiary Care ◽

Hospital Environment ◽

Healthcare Personnel ◽

Resistant Organism ◽

Surrogate Markers ◽

Antibiotic Resistant ◽

Contact Precautions ◽

Bacterial Cultures ◽

Fluorescent Powder

AbstractObjective:To assess potential transmission of antibiotic-resistant organisms (AROs) using surrogate markers and bacterial cultures.Design:Pilot study.Setting:A 1,260-bed tertiary-care academic medical center.Participants:The study included 25 patients (17 of whom were on contact precautions for AROs) and 77 healthcare personnel (HCP).Methods:Fluorescent powder (FP) and MS2 bacteriophage were applied in patient rooms. HCP visits to each room were observed for 2–4 hours; hand hygiene (HH) compliance was recorded. Surfaces inside and outside the room and HCP skin and clothing were assessed for fluorescence, and swabs were collected for MS2 detection by polymerase chain reaction (PCR) and selective bacterial cultures.Results:Transfer of FP was observed for 20 rooms (80%) and 26 HCP (34%). Transfer of MS2 was detected for 10 rooms (40%) and 15 HCP (19%). Bacterial cultures were positive for 1 room and 8 HCP (10%). Interactions with patients on contact precautions resulted in fewer FP detections than interactions with patients not on precautions (P < .001); MS2 detections did not differ by patient isolation status. Fluorescent powder detections did not differ by HCP type, but MS2 was recovered more frequently from physicians than from nurses (P = .03). Overall, HH compliance was better among HCP caring for patients on contact precautions than among HCP caring for patients not on precautions (P = .003), among nurses than among other nonphysician HCP at room entry (P = .002), and among nurses than among physicians at room exit (P = .03). Moreover, HCP who performed HH prior to assessment had fewer fluorescence detections (P = .008).Conclusions:Contact precautions were associated with greater HCP HH compliance and reduced detection of FP and MS2.

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Modeling Infectious Diseases in Healthcare Network (MInD-Healthcare) Framework for Describing and Reporting Multidrug-resistant Organism and Healthcare-Associated Infections Agent-based Modeling Methods

Clinical Infectious Diseases ◽

10.1093/cid/ciaa234 ◽

2020 ◽

Author(s):

Rachel B Slayton ◽

Justin J O’Hagan ◽

Sean Barnes ◽

Sarah Rhea ◽

Rainer Hilscher ◽

...

Keyword(s):

Infectious Diseases ◽

Multidrug Resistant ◽

Pathogen Transmission ◽

Model Verification ◽

Resistant Organism ◽

Healthcare Associated Infections ◽

State Variables ◽

Agent Based ◽

Healthcare Network ◽

Healthcare Associated

Abstract Mathematical modeling of healthcare-associated infections and multidrug-resistant organisms improves our understanding of pathogen transmission dynamics and provides a framework for evaluating prevention strategies. One way of improving the communication among modelers is by providing a standardized way of describing and reporting models, thereby instilling confidence in the reproducibility and generalizability of such models. We updated the Overview, Design concepts, and Details protocol developed by Grimm et al [11] for describing agent-based models (ABMs) to better align with elements commonly included in healthcare-related ABMs. The Modeling Infectious Diseases in Healthcare Network (MInD-Healthcare) framework includes the following 9 key elements: (1) Purpose and scope; (2) Entities, state variables, and scales; (3) Initialization; (4) Process overview and scheduling; (5) Input data; (6) Agent interactions and organism transmission; (7) Stochasticity; (8) Submodels; and (9) Model verification, calibration, and validation. Our objective is that this framework will improve the quality of evidence generated utilizing these models.

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Gut Microbiota Modulation for Multidrug-Resistant Organism Decolonization: Present and Future Perspectives

Frontiers in Microbiology ◽

10.3389/fmicb.2019.01704 ◽

2019 ◽

Vol 10 ◽

Cited By ~ 15

Author(s):

Livia Gargiullo ◽

Federica Del Chierico ◽

Patrizia D’Argenio ◽

Lorenza Putignani

Keyword(s):

Gut Microbiota ◽

Multidrug Resistant ◽

Resistant Organism ◽

Future Perspectives

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Frequent Acquisition of Multiple Strains of Methicillin-Resistant Staphylococcus aureus by Healthcare Workers in an Endemic Hospital Environment

Infection Control and Hospital Epidemiology ◽

10.2307/30146980 ◽

1990 ◽

Vol 11 (9) ◽

pp. 479-485 ◽

Cited By ~ 26

Author(s):

Steven M. Opal ◽

Kenneth H. Mayer ◽

Marjorie J. Stenberg ◽

Julia E. Blazek ◽

Dennis J. Mikolich ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Healthcare Workers ◽

Methicillin Resistant Staphylococcus Aureus ◽

Hospital Environment ◽

Methicillin Resistant ◽

Multiple Strains

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Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.131 ◽

2021 ◽

pp. 1-6

Author(s):

Katherine D. Ellingson ◽

Brie N. Noble ◽

Genevieve L. Buser ◽

Graham M. Snyder ◽

Jessina C. McGregor ◽

...

Keyword(s):

Acute Care ◽

Infection Prevention ◽

Multidrug Resistant ◽

Research Network ◽

Resistant Organism ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Hospital Size ◽

Academic Affiliation ◽

Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

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Comparison of saliva with healthcare workers- and patient-collected swabs in the diagnosis of COVID-19 in a large cohort

BMC Infectious Diseases ◽

10.1186/s12879-021-06343-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mitnala Sasikala ◽

Yelamanchili Sadhana ◽

Ketavarapu Vijayasarathy ◽

Anand Gupta ◽

Sarala Kumari Daram ◽

...

Keyword(s):

Healthcare Workers ◽

Early Stage ◽

Cost Effective ◽

Hospitalized Patients ◽

Detection Sensitivity ◽

Nasopharyngeal Swab ◽

Predictive Values ◽

Qrt Pcr ◽

Asymptomatic Patients ◽

Sensitivity Specificity

Abstract Background A considerable amount of evidence demonstrates the potential of saliva in the diagnosis of COVID-19. Our aim was to determine the sensitivity of saliva versus swabs collected by healthcare workers (HCWs) and patients themselves to assess whether saliva detection can be offered as a cost-effective, risk-free method of SARS-CoV-2 detection. Methods This study was conducted in a hospital involving outpatients and hospitalized patients. A total of 3018 outpatients were tested. Of these, 200 qRT-PCR-confirmed SARS-CoV-2-positive patients were recruited for further study. In addition, 101 SARS-CoV-2-positive hospitalized patients with symptoms were also enrolled in the study. From outpatients, HCWs collected nasopharyngeal swabs (NPS), saliva were obtained. From inpatients, HCWs collected swabs, patient-collected swabs, and saliva were obtained. qRT-PCR was performed to detect SARS-CoV-2 by TAQPATH assay to determine the sensitivity of saliva detection. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of detecting SARS-CoV-2 were calculated using MedCalc. Results Of 3018 outpatients (asymptomatic: 2683, symptomatic: 335) tested by qRT-PCR, 200 were positive (males: 140, females: 60; aged 37.9 ± 12.8 years; (81 asymptomatic, 119 symptomatic). Of these, saliva was positive in 128 (64%); 39 of 81 asymptomatic (47%),89 of 119 symptomatic patients (74.8%). Sensitivity of detection was 60.9% (55.4–66.3%, CI 95%), with a negative predictive value of 36%(32.9–39.2%, CI 95%).Among 101 hospitalized patients (males:65, females: 36; aged 53.48 ± 15.6 years), with HCW collected NPS as comparator, sensitivity of saliva was 56.1% (47.5–64.5, CI 95%), specificity 63.5%(50.4–75.3, CI95%) with PPV of 77.2% and NPV of 39.6% and that of self-swab was 52.3%(44–60.5%, CI95%), specificity 56.6% (42.3–70.2%, CI95%) with PPV 77.2% and NPV29.7%. Comparison of positivity with the onset of symptoms revealed highest detection in saliva on day 3 after onset of symptoms. Additionally, only saliva was positive in 13 (12.8%) hospitalized patients. Conclusion Saliva which is easier to collect than nasopharyngeal swab is a viable alternate to detect SARS-COV-2 in symptomatic patients in the early stage of onset of symptoms. Although saliva is currently not recommended for screening asymptomatic patients, optimization of collection and uniform timing of sampling might improve the sensitivity enabling its use as a screening tool at community level.

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Ceftolozane-tazobactam versus meropenem for definitive treatment of bloodstream infection due to extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales (“MERINO-3”): study protocol for a multicentre, open-label randomised non-inferiority trial

Trials ◽

10.1186/s13063-021-05206-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Adam G. Stewart ◽

Patrick N. A. Harris ◽

Mark D. Chatfield ◽

Roberta Littleford ◽

David L. Paterson

Keyword(s):

Bloodstream Infection ◽

Generation Cephalosporin ◽

Multidrug Resistant ◽

Definitive Treatment ◽

Resistant Organism ◽

Third Generation ◽

Beta Lactamase ◽

Open Label ◽

Extended Spectrum Beta Lactamase ◽

Extended Spectrum

Abstract Background Extended-spectrum beta-lactamase (ESBL) and AmpC-producing Enterobacterales are common causes of bloodstream infection. ESBL-producing bacteria are typically resistant to third-generation cephalosporins and result in a sizeable economic and public health burden. AmpC-producing Enterobacterales may develop third-generation cephalosporin resistance through enzyme hyper-expression. In no observational study has the outcome of treatment of these infections been surpassed by carbapenems. Widespread use of carbapenems may drive the development of carbapenem-resistant Gram-negative bacilli. Methods This study will use a multicentre, parallel group open-label non-inferiority trial design comparing ceftolozane-tazobactam and meropenem in adult patients with bloodstream infection caused by ESBL or AmpC-producing Enterobacterales. Trial recruitment will occur in up to 40 sites in six countries (Australia, Singapore, Italy, Spain, Saudi Arabia and Lebanon). The sample size is determined by a predefined quantity of ceftolozane-tazobactam to be supplied by Merck, Sharpe and Dohme (MSD). We anticipate that a trial with 600 patients contributing to the primary outcome analysis would have 80% power to declare non-inferiority with a 5% non-inferiority margin, assuming a 30-day mortality of 5% in both randomised groups. Once randomised, definitive treatment will be for a minimum of 5 days and a maximum of 14 days with the total duration determined by treating clinicians. Data describing demographic information, risk factors, concomitant antibiotics, illness scores, microbiology, multidrug-resistant organism screening, discharge and mortality will be collected. Discussion Participants will have bloodstream infection due to third-generation cephalosporin non-susceptible E. coli and Klebsiella spp. or Enterobacter spp., Citrobacter freundii, Morganella morganii, Providencia spp. or Serratia marcescens. They will be randomised 1:1 to ceftolozane-tazobactam 3 g versus meropenem 1 g, both every 8 h. Secondary outcomes will be a comparison of 14-day all-cause mortality, clinical and microbiological success at day 5, functional bacteraemia score, microbiological relapse, new bloodstream infection, length of hospital stay, serious adverse events, C. difficile infection, multidrug-resistant organism colonisation. The estimated trial completion date is December 2024. Trial registration The MERINO-3 trial is registered under the US National Institute of Health ClinicalTrials.gov register, reference number: NCT04238390. Registered on 23 January 2020.

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S. pseudintermedius and S. aureus lineages with transmission ability circulate as causative agents of infections in pets for years

BMC Veterinary Research ◽

10.1186/s12917-020-02726-4 ◽

2021 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Laura Ruiz-Ripa ◽

Carmen Simón ◽

Sara Ceballos ◽

Carmelo Ortega ◽

Myriam Zarazaga ◽

...

Keyword(s):

Treatment Options ◽

Companion Animals ◽

Clinical History ◽

Multidrug Resistant ◽

Hospital Environment ◽

Antimicrobial Resistance Profile ◽

Causative Agents ◽

Veterinary Hospital ◽

Coagulase Positive Staphylococci

Abstract Background Staphylococcus pseudintermedius (SP) and Staphylococcus aureus (SA) are common colonizers of companion animals, but they are also considered opportunistic pathogens, causing diseases of diverse severity. This study focused on the identification and characterization of 33 coagulase-positive staphylococci isolated from diseased pets (28 dogs and five cats) during 2009–2011 in a veterinary hospital in Spain in order to stablish the circulating lineages and their antimicrobial resistance profile. Results Twenty-eight isolates were identified as SP and five as SA. Nine methicillin-resistant (MR) isolates (27%) carrying the mecA gene were detected (eight MRSP and one MRSA). The 55% of SP and SA isolates were multidrug-resistant (MDR). MRSP strains were typed as ST71-agrIII-SCCmecII/III-(PFGE) A (n=5), ST68-agrIV-SCCmecV-B1/B2 (n=2), and ST258-agrII-SCCmecIV-C (n=1). SP isolates showed resistance to the following antimicrobials [percentage of resistant isolates/resistance genes]: penicillin [82/blaZ], oxacillin [29/mecA] erythromycin/clindamycin [43/erm(B)], aminoglycosides [18–46/aacA-aphD, aphA3, aadE], tetracycline [71/tet(M), tet(K)], ciprofloxacin [29], chloramphenicol [29/catpC221], and trimethoprim-sulfamethoxazole [50/dfrG, dfrK]. The dfrK gene was revealed as part of the radC-integrated Tn559 in two SP isolates. Virulence genes detected among SP isolates were as follow [percentage of isolates]: siet [100], se-int [100], lukS/F-I [100], seccanine [7], and expB [7]. The single MRSA-mecA detected was typed as t011-ST398/CC398-agrI-SCCmecV and was MDR. The methicillin-susceptible SA isolates were typed as t045-ST5/CC5 (n=2), t10576-ST1660 (n=1), and t005-ST22/CC22 (n=1); the t005-ST22 feline isolate was PVL-positive and the two t045-ST45 isolates were ascribed to Immune Evasion Cluster (IEC) type F. Moreover, the t10576-ST1660 isolate, of potential equine origin, harbored the lukPQ and scneq genes. According to animal clinical history and data records, several strains seem to have been acquired from different sources of the hospital environment, while some SA strains appeared to have a human origin. Conclusions The frequent detection of MR and MDR isolates among clinical SP and SA strains with noticeable virulence traits is of veterinary concern, implying limited treatment options available. This is the first description of MRSA-ST398 and MRSP-ST68 in pets in Spain, as well the first report of the dfrK-carrying Tn559 in SP. This evidences that current transmissible lineages with mobilizable resistomes have been circulating as causative agents of infections among pets for years.

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