511. MDRO Carriage in Patients in Two ICUs and Prevalence of Environmental Surface and Healthcare Worker Hand Contamination

Abstract Background Determining MDRO (multidrug-resistant organism) transmission routes in intensive care units (ICUs) can be complex and require the evaluation of multiple potential MDRO sources, including patients, the environment, and healthcare worker (HCW) hands. The objective of this study was to determine MDRO carriage in patients in two separate ICUs, and simultaneous environmental and HCW hand contamination from associated rooms. Methods Patient (P), environmental (E), and HCW hand (H) samples were collected from hospital A (1183 H, 1253 E, 729 P) and hospital B (699 H, 1372 E, 437 P) over approximately 5 weeks in each unit. Environmental and HCW hand samples were collected using a cellulose sponge. HCW hand samples were collected prior to any hand hygiene. Patient samples were collected from the axilla, groin, and perianal areas with a flocked swab with patient consent. All samples were tested semi-quantitatively for Clostridium difficile (Cdiff), vancomycin-resistant enterococci (VRE), and cefotaxime-resistant Enterobacteriaceae (Cef-R-Ent) by selective culture. Cdiff isolates representative of each P/E/H cluster were tested for Cdiff toxin testing by PCR. Results Cdiff, VRE, and Cef-R-Ent were detected in patients, patient rooms, and on HCW hands in both facilities (Table 1). Cdiff was more prevalent in Facility A, while Cef-R-Ent was more prevalent in Facility B. The prevalence of VRE was minimal in both facilities. Cdiff toxin gene testing revealed that 17% of the Cdiff isolate clusters tested positive for toxin genes. In Facility A, the prevalence of a given MDRO was similar regardless of sample type, but was more widely varied between sample types in Facility B. Prevalence of MDROs on HCW hands and in the environment was typically higher in Facility A compared with Facility B. Individual patient positives were frequently linked to positive HCW hand and environmental cultures. Conclusion We discovered a low prevalence of all MDROs in both facilities, with most positive cultures associated with patients who were not on MDRO precautions. HCW hand and environmental MDRO prevalence was generally similar for each MDRO, regardless of patient prevalence, supporting previously reported links on HCW hand contamination and hospital room surfaces. Disclosures All authors: No reported disclosures.

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Control of Endemic Glycopeptide-Resistant Enterococci

Infection Control and Hospital Epidemiology ◽

10.1086/647297 ◽

1996 ◽

Vol 17 (5) ◽

pp. 286-292 ◽

Cited By ~ 10

Author(s):

Louise M. Dembry ◽

Keke Uzokwe ◽

Marcus J. Zervos

Keyword(s):

Enterococcus Faecalis ◽

Enterococcus Faecium ◽

Control Measures ◽

Resistant Organism ◽

Renal Unit ◽

Vancomycin Resistant ◽

Enterococcus Gallinarum ◽

Low Prevalence ◽

And Control ◽

Community Teaching

AbstractObjective:To evaluate the epidemiology of, and control measures for, vancomycin-resistantEnterococcus(VRE) in a renal unit.Design:A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit.Setting:A 975-bed community teaching hospital.Patients:Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period.Interventions/Control Measures:Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day).Results:Seven patients with VRE (8 isolates) were identified. Five isolates wereEnterococcus faecium(vancomycin MIC=16 to 256 μg/mL), two wereEnterococcus faecalis(MICs=16 and 124 μg/mL), and one wasEnterococcus gallinarum(MIC=8.0 μg/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified.Conclusions:Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic vancomycin-resistantEnterococcus.

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Multidrug-Resistant Organism Carriage in Wisconsin Children

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.925 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s324-s325

Author(s):

Ashley Kates ◽

Nathan Putman-Buehler ◽

Lauren Watson ◽

Tamara LeCaire ◽

Kristen Malecki ◽

...

Keyword(s):

Multidrug Resistant ◽

Cross Sectional Study ◽

Kindergarten Children ◽

Resistant Organism ◽

Small Pilot Study ◽

Cross Sectional ◽

Vancomycin Resistant Enterococci ◽

Increased Risk ◽

Stool Samples ◽

Vancomycin Resistant

Background: Children attending daycare are at increased risk of carrying multidrug-resistant organisms (MDROs) compared to children not attending daycare. Carriage of MDROs greatly increases the risk of infection, not only in the child but also for others living in the household. Understanding the epidemiology of MDRO carriage in children is essential to devising effective containment strategies. Here, we present the findings from a cross-sectional study assessing MDRO carriage in daycare-attending and nonattending children in Wisconsin. Methods: We applied the following enrollment criteria: Children aged between 6 months and <6 years and not enrolled in kindergarten; children who did not have an MDRO infection in the previous 6 months and did not receive any antimicrobials in the previous month; and children who did not have a gluten allergy, asthma, eczema, allergic rhinitis, cystic fibrosis, or an immunodeficiency. Children were enrolled by a parent or guardian who filled out a questionnaire on MDRO risk factor history and diet. Samples were collected from the nares, axilla or groin (pooled swab), and stool. Nasal samples were cultured for H. influenzae, S. pneumoniae, M. catarrhalis, and methicillin-resistant S. aureus (MRSA). Skin samples were cultured for MRSA, and stool samples were cultured for MRSA, C. difficile, vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase–producing Gram-negative bacilli (ie, ESBL GNR). Results: In total, 44 children were enrolled in this study. The average age was 2.6 years and 50% were girls. Furthermore, 30 (68.2%) were identified by their parents as white, 9 (20.5%) as black, and 5 (11.3%) as other or multiracial. Incidentally, 23 children (52.3%) were enrolled in daycare. Overall, 18 children were positive for at least 1 organism, 9 of which had daycare exposure, and 5 children (1 in daycare) were positive for >1 organism (11.4%). From stool samples, 6 children (13.6%, 2 in daycare) were C. difficile carriers, 3 were VRE carriers (6.8%, 1 in daycare), 8 carried an ESBL GNR (18.2%, 4 in daycare), and 3 carried MRSA (6.8%, 1 in daycare). One child was positive for H. influenzae (2.3%, not in daycare) and 2 were positive for S. pneumoniae (4.6%, 1 in daycare) from nares swabs. One child was positive for MRSA (2.3%, not in daycare) from a skin swab. We detected no significant differences between children with and without daycare exposure for any organism. Conclusions: Children in this population had higher than expected rates of ESBL GNRs and MRSA for a community population. Daycare exposure was not correlated with increased carriage in this small pilot study, though larger longitudinal studies are needed.Funding: NoneDisclosures: None

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The Role of Healthcare Worker-Mediated Contact Networks in the Transmission of Vancomycin-Resistant Enterococci

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa056 ◽

2020 ◽

Vol 7 (3) ◽

Author(s):

Eili Y Klein ◽

Katie K Tseng ◽

Jeremiah Hinson ◽

Katherine E Goodman ◽

Aria Smith ◽

...

Keyword(s):

Healthcare Worker ◽

Multidrug Resistant ◽

Surveillance Culture ◽

Health Records ◽

Contact Networks ◽

Vancomycin Resistant Enterococci ◽

Vancomycin Resistant ◽

Mediated Contact ◽

The Impact

Abstract Background User- and time-stamped data from hospital electronic health records (EHRs) present opportunities to evaluate how healthcare worker (HCW)-mediated contact networks impact transmission of multidrug-resistant pathogens, such as vancomycin-resistant enterococci (VRE). Methods This is a retrospective analysis of incident acquisitions of VRE between July 1, 2016 and June 30, 2018. Clinical and demographic patient data were extracted from the hospital EHR system, including all recorded HCW contacts with patients. Contacts by an HCW with 2 different patients within 1 hour was considered a “connection”. Incident VRE acquisition was determined by positive clinical or surveillance cultures collected ≥72 hours after a negative surveillance culture. Results There were 2952 hospitalizations by 2364 patients who had ≥2 VRE surveillance swabs, 112 (4.7%) patients of which had incident nosocomial acquisitions. Patients had a median of 24 (interquartile range [IQR], 18–33) recorded HCW contacts per day, 9 (IQR, 5–16) of which, or approximately 40%, were connections that occurred <1 hour after another patient contact. Patients that acquired VRE had a higher average number of daily connections to VRE-positive patients (3.1 [standard deviation {SD}, 2.4] versus 2.0 [SD, 2.1]). Controlling for other risk factors, connection to a VRE-positive patient was associated with increased odds of acquiring VRE (odds ratio, 1.64; 95% confidence interval, 1.39–1.92). Conclusions We demonstrated that EHR data can be used to quantify the impact of HCW-mediated patient connections on transmission of VRE in the hospital. Defining incident acquisition risk of multidrug-resistant organisms through HCWs connections from EHR data in real-time may aid implementation and evaluation of interventions to contain their spread.

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2570. A Randomized Controlled Trial of Lactobacillus rhamnosus GG on Multidrug-Resistant Organism (MDRO) Colonization

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2248 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S893-S893

Author(s):

Adriana M Rauseo ◽

Tiffany Hink ◽

Kimberly Reske ◽

Sondra Seiler ◽

Kerry Bommarito ◽

...

Keyword(s):

Controlled Trial ◽

Lactobacillus Rhamnosus ◽

Multidrug Resistant ◽

Resistant Organism ◽

Lactobacillus Rhamnosus Gg ◽

Antibiotic Resistant ◽

Clostridioides Difficile ◽

Vancomycin Resistant ◽

Double Blinded ◽

To Receive

Abstract Background MDRO present a greater threat to public health than ever before, and antimicrobial options are decreasing. Altered colonic microbiota following antimicrobial exposure allows for subsequent colonization by MDRO. Ingestion of prophylactic Lactobacillus rhamnosus GG (LGG) could be an approach to prevent the spread of, and subsequent infection due to MDRO, by promoting a healthy bacterial milieu within the colon. Methods This is a prospective, double-blinded, randomized clinical trial in which a total of 87 subjects on broad-spectrum antibiotics were randomized to receive LGG twice daily (n = 43) vs placebo (n = 44). Stool or rectal swab specimens were collected for culture at enrollment, every 3 days during admission, and at discharge. Selective media were used to detect the following MDRO: Clostridioides difficile (CD), vancomycin-resistant Enterococcus (VRE), and antibiotic-resistant Gram-negatives (GN). The primary outcome was MDRO acquisition. Secondary outcomes included analysis for loss of any MDRO if colonized at enrollment, and acquisition or loss of individual MDRO. Results Subjects in both groups had similar prevalence of colonization with any MDRO at study enrollment (LGG 40% vs. placebo 39%), with similar colonization prevalence for individual MDRO (Figure 1). There was no difference in any MDRO acquisition (LGG 27%, placebo 33%, OR 1.36, 95% CI 0.42–4.41) or any individual MDRO acquisition (Figure 2). There was also no difference in loss of any MDRO (LGG 18%, placebo 24%, OR 1.44, 95% CI 0.27–7.68) or any individual MDRO (Figure 2). Conclusion LGG administration did not prevent acquisition of MDRO or accelerate loss of MDRO colonization. Disclosures All authors: No reported disclosures.

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Prevalence of and Factors Associated With Multidrug Resistant Organism (MDRO) Colonization in 3 Nursing Homes

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.215 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1485-1488 ◽

Cited By ~ 21

Author(s):

James A. McKinnell ◽

Loren G. Miller ◽

Raveena Singh ◽

Ken Kleinman ◽

Ellena M. Peterson ◽

...

Keyword(s):

Random Sampling ◽

Nursing Home Residents ◽

Multidrug Resistant ◽

Resistant Organism ◽

Care Needs ◽

Point Prevalence Study ◽

Factors Associated ◽

Carbapenem Resistant ◽

History Of ◽

Vancomycin Resistant

Nursing home residents are at risk for acquiring and transmitting MDROs. A serial point-prevalence study of 605 residents in 3 facilities using random sampling found MDRO colonization in 45% of residents: methicillin-resistant Staphylococcus aureus (MRSA, 26%); extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL, 17%); vancomycin-resistant Enterococcus spp. (VRE, 16%); carbapenem-resistant Enterobacteriaceae (CRE, 1%). MDRO colonization was associated with history of MDRO, care needs, incontinence, and catheters.Infect Control Hosp Epidemiol 2016;1485–1488

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Ability of chlorhexidine, octenidine, polyhexanide and chloroxylenol to inhibit metabolism of biofilm-forming clinical multidrug-resistant organisms

Journal of Infection Prevention ◽

10.1177/1757177420963829 ◽

2020 ◽

pp. 175717742096382

Author(s):

Frank Günther ◽

Brigitte Blessing ◽

Ulrike Dapunt ◽

Alexander Mischnik ◽

Nico T Mutters

Keyword(s):

In Vitro Study ◽

Multidrug Resistant ◽

Chlorhexidine Gluconate ◽

Metabolic Inhibition ◽

Resistant Bacteria ◽

Gram Negative Bacteria ◽

Viability Assay ◽

Environmental Surface ◽

Vancomycin Resistant

Purpose: This in vitro study was designed to determine if standard antiseptics used for skin and environmental surface cleansing can disrupt the metabolic activity (as a measure of viability) of multidrug-resistant gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus isolates within their native biofilms. Methods: Sixty clinical isolates of multidrug-resistant bacteria were selected for testing in different chlorhexidine gluconate, octenidine, polyhexanide and chloroxylenol concentrations. Metabolic inhibition of biofilm for each clinical isolate was analysed using a biofilm viability assay. Results: Chlorhexidine gluconate (mean = 83.8% ± 9.8%) and octenidine (mean = 84.5% ± 6.8%) showed the greatest efficacy against biofilms of the tested microorganisms, with the greatest efficacies against MRSA. The antiseptics demonstrated the least efficacy against biofilms of Pseudomonas aeruginosa. Conclusion: Chlorhexidine gluconate and octenidine showed the greatest level of bacterial metabolic inhibition and were statistically equivalent. Polyhexanide was more effective than chloroxylenol, but both were inferior to chlorhexidine gluconate and octenidine against the tested organisms.

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Laboratory-identified vancomycin-resistant enterococci bacteremia incidence: A standardized infection ratio prediction model

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.215 ◽

2021 ◽

pp. 1-5

Author(s):

Sukarma S. S. Tanwar ◽

Lindsey M. Weiner-Lastinger ◽

Jeneita M. Bell ◽

Katherine Allen-Bridson ◽

Suparna Bagchi ◽

...

Keyword(s):

Prevalence Rate ◽

Average Length ◽

Healthcare Facility ◽

Multidrug Resistant ◽

Resistant Organism ◽

Hospital Level ◽

Clostridioides Difficile ◽

Vancomycin Resistant ◽

Oncology Unit ◽

Community Onset

Abstract Background: We analyzed 2017 healthcare facility-onset (HO) vancomycin-resistant Enterococcus (VRE) bacteremia data to identify hospital-level factors that were significant predictors of HO-VRE using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) multidrug-resistant organism and Clostridioides difficile reporting module. A risk-adjusted model that can be used to calculate the number of predicted HO-VRE bacteremia events in a facility was developed, thus enabling the calculation of VRE standardized infection ratios (SIRs). Methods: Acute-care hospitals reporting at least 1 month of 2017 VRE bacteremia data were included in the analysis. Various hospital-level characteristics were assessed to develop a best-fit model and subsequently derive the 2018 national and state SIRs. Results: In 2017, 470 facilities in 35 states participated in VRE bacteremia surveillance. Inpatient VRE community-onset prevalence rate, average length of patient stay, outpatient VRE community-onset prevalence rate, and presence of an oncology unit were all significantly associated (all 95% likelihood ratio confidence limits excluded the nominal value of zero) with HO-VRE bacteremia. The 2018 national SIR was 1.01 (95% CI, 0.93–1.09) with 577 HO bacteremia events reported. Conclusion: The creation of an SIR enables national-, state-, and facility-level monitoring of VRE bacteremia while controlling for individual hospital-level factors. Hospitals can compare their VRE burden to a national benchmark to help them determine the effectiveness of infection prevention efforts over time.

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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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Multiresistant Bacteria Isolated from Intestinal Faeces of Farm Animals in Austria

Antibiotics ◽

10.3390/antibiotics10040466 ◽

2021 ◽

Vol 10 (4) ◽

pp. 466

Author(s):

Herbert Galler ◽

Josefa Luxner ◽

Christian Petternel ◽

Franz F. Reinthaler ◽

Juliana Habib ◽

...

Keyword(s):

Meat Products ◽

Animal Husbandry ◽

Multidrug Resistant ◽

Farm Animals ◽

Resistant Bacteria ◽

Antibiotic Resistant Bacteria ◽

Antibiotic Resistant ◽

E Coli ◽

Multiresistant Bacteria ◽

Vancomycin Resistant

In recent years, antibiotic-resistant bacteria with an impact on human health, such as extended spectrum β-lactamase (ESBL)-containing Enterobacteriaceae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE), have become more common in food. This is due to the use of antibiotics in animal husbandry, which leads to the promotion of antibiotic resistance and thus also makes food a source of such resistant bacteria. Most studies dealing with this issue usually focus on the animals or processed food products to examine the antibiotic resistant bacteria. This study investigated the intestine as another main habitat besides the skin for multiresistant bacteria. For this purpose, faeces samples were taken directly from the intestines of swine (n = 71) and broiler (n = 100) during the slaughter process and analysed. All samples were from animals fed in Austria and slaughtered in Austrian slaughterhouses for food production. The samples were examined for the presence of ESBL-producing Enterobacteriaceae, MRSA, MRCoNS and VRE. The resistance genes of the isolated bacteria were detected and sequenced by PCR. Phenotypic ESBL-producing Escherichia coli could be isolated in 10% of broiler casings (10 out of 100) and 43.6% of swine casings (31 out of 71). In line with previous studies, the results of this study showed that CTX-M-1 was the dominant ESBL produced by E. coli from swine (n = 25, 83.3%) and SHV-12 from broilers (n = 13, 81.3%). Overall, the frequency of positive samples with multidrug-resistant bacteria was lower than in most comparable studies focusing on meat products.

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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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