514. Shedding of Multidrug-Resistant Gram-Negative Bacilli by Colonized Patients during Procedures and Patient Care Activities

Abstract Background Contaminated environmental surfaces contribute to transmission of healthcare-associated pathogens such as multidrug-resistant gram-negative bacilli. We hypothesized that medical procedures and patient care activities facilitate environmental dissemination of multidrug-resistant gram-negative bacilli in hospitalized patients. Methods We conducted a cohort study of hospitalized patients in contact precautions for carriage of extended-spectrum β-lactamase (ESBL)-producing or carbapenem-resistant gram-negative bacilli (CR-GNB) to determine the frequency of environmental shedding during procedures and care activities. Perirectal, wound, and skin were cultured for the gram-negative bacilli of interest. Prior to each procedure or activity, surfaces in the room and portable equipment used for procedures were disinfected. After procedures, high-touch surfaces and portable equipment were cultured; negative control cultures were collected after 1 hour in the absence of a procedure. Results Of 60 participants, 38 (63%) were in contact precautions for ESBL-producing gram-negative bacilli and 22 (37%) for CR-GNB. Thirty-four (57%) participants had positive perirectal, wound, or skin cultures. Contamination of surfaces with the colonizing multidrug-resistant gram-negative bacilli occurred frequently during procedures and activities such as wound care, assistance with meals, and urinary catheter or colostomy care (11% to 29% of procedures/activities), whereas contamination was rare in the absence of a procedure (1%). Contamination was recovered from 6 of 56 (10%) portable devices used for procedures. Conclusion Environmental shedding of multidrug-resistant gram-negative bacilli occurs frequently during medical and non-medical procedures in hospitalized patients. Our results suggest that there is a need for effective strategies to disinfect surfaces and equipment after procedures. Disclosures All authors: No reported disclosures.

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Shedding of methicillin-resistant Staphylococcus aureus by colonized patients during procedures and patient care activities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.342 ◽

2019 ◽

Vol 40 (3) ◽

pp. 328-332 ◽

Cited By ~ 4

Author(s):

Heba Alhmidi ◽

Jennifer L. Cadnum ◽

Sreelatha Koganti ◽

Annette L. Jencson ◽

Joseph D. Rutter ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Patient Care ◽

Bivariate Analysis ◽

Medical Procedures ◽

Positive Skin ◽

Methicillin Resistant ◽

Contact Precautions ◽

Effective Strategies ◽

Observational Cohort ◽

Healthcare Associated

AbstractObjective:Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA).Design:Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.Setting:A Veterans Affairs hospital.Participants:This study included 75 patients in contact precautions for MRSA colonization or infection.Results:Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04).Conclusions:Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.

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Faculty Opinions recommendation of ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718224421.793494780 ◽

2014 ◽

Author(s):

Peter Wilson ◽

Carmel Curtis

Keyword(s):

Infection Control ◽

Multidrug Resistant ◽

Hospitalized Patients ◽

Control Measures ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Infection Control Measures

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Susceptibility of Multidrug-Resistant Gram-Negative Urine Isolates to Oral Antibiotics

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02961-15 ◽

2016 ◽

Vol 60 (5) ◽

pp. 3138-3140 ◽

Cited By ~ 14

Author(s):

Elizabeth B. Hirsch ◽

Paola C. Zucchi ◽

Alice Chen ◽

Brian R. Raux ◽

James E. Kirby ◽

...

Keyword(s):

Emergency Department ◽

Treatment Options ◽

Multidrug Resistant ◽

Hospitalized Patients ◽

Oral Antibiotics ◽

Gram Negative ◽

Susceptibility Data ◽

Oral Agents ◽

High Prevalence

ABSTRACTIncreasing resistance among Gram-negative uropathogens limits treatment options, and susceptibility data for multidrug-resistant isolates are limited. We assessed the activity of five oral agents against 91 multidrug-resistant Gram-negative urine isolates that were collected from emergency department/hospitalized patients. Fosfomycin and nitrofurantoin were most active (>75% susceptibility). Susceptibilities to sulfamethoxazole-trimethoprim, ciprofloxacin, and ampicillin were ≤40%; empirical use of these agents likely provides inadequate coverage in areas with a high prevalence of multidrug-resistant uropathogens.

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Depression and anxiety in hospitalized patients on contact precautions for multidrug-resistant microorganisms

Infection Disease & Health ◽

10.1016/j.idh.2020.01.002 ◽

2020 ◽

Vol 25 (3) ◽

pp. 133-139 ◽

Cited By ~ 2

Author(s):

Eline Maria Granzotto ◽

Aline Maciel Gouveia ◽

Juliano Gasparetto ◽

Letícia Ramos Dantas ◽

Felipe Francisco Tuon

Keyword(s):

Multidrug Resistant ◽

Hospitalized Patients ◽

Depression And Anxiety ◽

Contact Precautions

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Controlling the Diffusion of Multidrug-Resistant Organisms in Intensive Care Units

Seminars in Respiratory and Critical Care Medicine ◽

10.1055/s-0039-1696980 ◽

2019 ◽

Vol 40 (04) ◽

pp. 558-568 ◽

Cited By ~ 3

Author(s):

Solen Kernéis ◽

Jean-Christophe Lucet

Keyword(s):

Intensive Care ◽

Hand Hygiene ◽

Intensive Care Units ◽

Multidrug Resistant ◽

Control Measures ◽

Behavioral Approach ◽

Gram Negative Bacteria ◽

Gram Negative ◽

Contact Precautions ◽

Multidrug Resistant Organisms

AbstractThe prevalence of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) is increasing worldwide, with very large variations across countries, microorganisms, and settings. Emerging MDR gram-negative bacteria and fungi raise particular concerns that require improved prevention and control strategies. Vertical approaches are mainly based on screening and contact precautions and/or decolonization of MDRO carriers. On the other hand, horizontal strategies are not pathogen-specific and include standard precautions (i.e., hand hygiene), universal decolonization, antimicrobial stewardship, and environmental cleaning. The impacts of the different strategies vary between MDROs and compliance with control measures, and are intermixed in most infection control programs. Based on historical data, hand hygiene remains the cornerstone to prevent transmission of MDROs in ICUs. In the context of high hand hygiene compliance, screening and contact precautions for carriers seem to have a limited additional effect, particularly for MDR gram-negative bacteria. Studies on skin decolonization with chlorhexidine bathing show conflicting results, impairing its widespread adoption. Selective oral and digestive decontaminations have shown positive impact on clinical outcomes in ICUs with low levels of antibiotic resistance, but raised ecological concerns in high-prevalence settings. Antibiotic stewardship programs have been associated with reductions in antimicrobial use, duration of stay, and costs with no negative impact on mortality and should be widely promoted in ICUs. Whatever the strategy, compliance with the recommended measures is of crucial importance and implementation should rely on behavioral approach and change in the institutional and safety culture.

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Epidemiology of Multidrug-resistant Bacteria Isolated from Hospitalized Patients in a Regional Central Hospital in China

10.21203/rs.3.rs-136460/v1 ◽

2020 ◽

Author(s):

Jixun Zhang ◽

Rui Li ◽

Zhenzhong Liu ◽

Chao Wang

Keyword(s):

Pseudomonas Aeruginosa ◽

Acinetobacter Baumannii ◽

Multidrug Resistant ◽

Hospitalized Patients ◽

Resistant Bacteria ◽

Central Hospital ◽

Gram Negative ◽

E Coli ◽

Significant Difference ◽

The Impact

Abstract Objectives: Considering the dynamic changes of MDR, we did an up-to-date study and analyzed the impact of MDR on the outcome of patients. Design: Collected MDR isolated from hospitalized patients between June 2018 and May 2020 and performed retrospective analysis. Setting: This study was conducted in a public regional central hospital in China.Patients: 1156 patients with MDR infections.Results: Total 1291 MDRS were isolated, intensive care unit (ICU) accounted for 32.3% as the most. The main samples were sputum (75.1%) and 89.6% MDR were Gram-negative. The most common MDR were Acinetobacter baumannii, carbapenemase-producing K. pneumoniae, Pseudomonas aeruginosa, ESBL-producing E. coli. Methicillin-resistant Staphylococcus aureus (MRSA) and ESBL-producing K.pneumoniae. 35.6% were nosocomial infections and 64.4% were community-acquired infections. There was a statistically significant difference in mortality between patients infected with MDR and those with non-MDR (7.4% [32/432] vs 2.6% [17/655]; P = 0.001). The Acinetobacter baumannii and Klebsiella pneumoniae were mainly sensitive to tigecycline. The Pseudomonas aeruginosa was mainly sensitive to amikacin and levofloxacin. More than 80% of the Escherichia coli were sensitive to tigecycline and carbapenems. More than 90% of MRSA were sensitive to vancomycin, linezolid, and quinoprptin / daptoptin.Conclusions: The MDRS are mainly gram-negative bacteria. ICU contributes most MDR and pulmonary infection is the main origin of MDR. MDR infection is an independent risk factor for death. ESBL-producing Enterobacteriaceae, especially carbapenemase producing Enterobacteriaceae, should be paid more attention. This study is helpful to understand the distribution of MDR in hospital and the extent of antibiotic resistance.

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Extended Spectrum β-Lactamase (ESBL) Producing Multidrug Resistant Gram-Negative Bacteria from Various Clinical Specimens of Patients Visiting a Tertiary Care Hospital

Tribhuvan University Journal of Microbiology ◽

10.3126/tujm.v4i0.21667 ◽

2018 ◽

Vol 4 ◽

pp. 1-8

Author(s):

Albert Ghimire ◽

Bipesh Acharya ◽

Reshma Tuladhar

Keyword(s):

Susceptibility Testing ◽

Multidrug Resistant ◽

Hospitalized Patients ◽

Diffusion Method ◽

Gram Negative Bacteria ◽

Care Hospital ◽

Gram Negative ◽

Clinical Specimens ◽

Extended Spectrum ◽

Esbl Producers

Objectives: The purpose of this study was to assess multidrug resistance and Extended Spectrum β-Lactamase (ESBL) production in Gram negative bacterial pathogens.Methods: The study included clinical specimens sent for routine culture and antibiotic susceptibility testing. A total of 469 different clinical specimens were processed according to the standard methodology. The isolates were identified by standard microbiological procedures and subjected to antimicrobial susceptibility testing by modified Kirby-Bauer disk diffusion method. Production of ESBL was determined by combined disk method.Results: Of the total sample processed, 80 (17.0%) Gram negative bacteria were isolated and 82.5% of them were multidrug resistant (MDR). From the total MDR isolates, 47% were ESBL positive. The higher rate of growth among Intensive Care Units (ICUs) patients was found statistically significant. Higher prevalence of MDR isolates was observed in blood and pus specimens. The majority of the ESBL producers were Escherichia coli (38.7%). Higher rate of ESBL producers was detected from blood (55.6%). Polymyxin B, imipenem and amikacin were the most effective antibiotics against Acinetobacter spp. and Pseudomonas aeruginosa whereas imipenem, amikacin, meropenem were the most effective antibiotics against Enterobacteriaceae.Conclusion: Higher prevalence of ESBL producing MDR Gram negative pathogens in hospitalized patients indicates these bacteria are important health care associated pathogens and requires proper infection control measures that check the transfer of MDR and β-lactamase producing bacterial pathogens among the hospitalized patients.

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