scholarly journals Import of multidrug-resistant bacteria from abroad through interhospital transfers, Finland, 2010–2019

2021 ◽  
Vol 26 (39) ◽  
Author(s):  
Mikael Kajova ◽  
Tamim Khawaja ◽  
Jonas Kangas ◽  
Hilda Mäkinen ◽  
Anu Kantele
Keyword(s):  
Risk Factors ◽  
Multivariable Analysis ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Predisposing Factors ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Tropical Regions ◽  
Carbapenemase Gene ◽  
Icu Treatment

Background While 20–80% of regular visitors to (sub)tropical regions become colonised by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), those hospitalised abroad often also carry other multidrug-resistant (MDR) bacteria on return; the rates are presumed to be highest for interhospital transfers. Aim This observational study assessed MDR bacterial colonisation among patients transferred directly from hospitals abroad to Helsinki University Hospital. We investigated predisposing factors, clinical infections and associated fatalities. Methods Data were derived from screening and from diagnostic samples collected between 2010 and 2019. Risk factors of colonisation were identified by multivariable analysis. Microbiologically verified symptomatic infections and infection-related mortality were recorded during post-transfer hospitalisation. Results Colonisation rates proved highest for transfers from Asia (69/96; 71.9%) and lowest for those within Europe (99/524; 18.9%). Of all 698 patients, 208 (29.8%) were colonised; among those, 163 (78.4%) carried ESBL-PE, 28 (13.5%) MDR Acinetobacter species, 25 (12.0%) meticillin-resistant Staphylococcus aureus, 25 (12.0%) vancomycin-resistant Enterococcus, 14 (6.7%) carbapenemase-producing Enterobacteriaceae, and 12 (5.8%) MDR Pseudomonas aeruginosa; 46 strains tested carbapenemase gene-positive. In multivariable analysis, geographical region, intensive care unit (ICU) treatment and antibiotic use abroad proved to be risk factors for colonisation. Clinical MDR infections, two of them fatal (1.0%), were recorded for 22 of 208 (10.6%) MDR carriers. Conclusions Colonisation by MDR bacteria was common among patients transferred from foreign hospitals. Region of hospitalisation, ICU treatment and antibiotic use were identified as predisposing factors. Within 30 days after transfer, MDR colonisation manifested as clinical infection in more than 10% of the carriers.

scholarly journals Revisiting travellers’ diarrhoea justifying antibiotic treatment: prospective study

2020 ◽  
Author(s):  
A Turunen Katri ◽  
A Kantele
Keyword(s):  
Risk Factors ◽  
Antibiotic Treatment ◽  
Multivariable Analysis ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Campylobacter Coli ◽  
Related Factors ◽  
Heat Stable ◽  
Before And After

Abstract Background As antimicrobials increase the risk of acquiring multidrug-resistant (MDR) bacteria, unnecessary antibiotics should be avoided for travellers’ diarrhoea (TD). Antibiotics are recommended in TD accompanied by fever or incapacitation (TD justifying use of antibiotics, TDjuAB). Seeking tools for reducing antibiotic use, we explored factors predisposing to TDjuAB and scrutinized antibiotic treatment among those with TDjuAB and those with diarrhoea not justifying antibiotics. Methods We conducted a study among 370 prospectively recruited visitors to the tropics. Stool samples and questionnaires were collected before and after travel. Enteric pathogens were analysed by qPCR for enteropathogenic (EPEC), enteroaggregative (EAEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC), and enteroinvasive (EIEC) E. coli/Shigella, Campylobacter, Salmonella, Yersinia and Vibrio cholerae, and for ETEC’s toxins LT (heat-labile), STh (human heat-stable) and STp (porcine heat-stable). TD was defined by the WHO criteria and TDjuAB as diarrhoea accompanied by fever, and/or disrupting or preventing daily activities. Multivariable analysis was applied—separately for travel-related factors and pathogens—to identify risk factors for TDjuAB(+). Results Among the 370 travellers, TD was contracted by 253 (68%), categorized as TDjuAB(+) in 93/253 (37%) and TDjuAB(−) in 160/253 (63%) of the cases. Antibiotics were used for TD by 41% in TDjuAB(+) and by 7% in the TDjuAB(−) group. Relative risk ratios (RRR) s are presented for both the TDjuAB(+) and the TDjuAB(−) groups. TDjuAB(+) was associated with long travel duration and young age. Among the 298 subjects not having taken antibiotics, increased RRRs were found e.g. for findings of Campylobacter coli/jejuni and ETEC’s STh toxin. Conclusions The first to analyse risk factors for TDjuAB, our study presents RRRs for demographic and behavioural factors and for various pathogens. Only less than half of those in the TDjuAB(+) group took antibiotics, which demonstrates that most cases meeting the current criteria recover without antimicrobial treatment.

scholarly journals 157. patient to Environment Transmission of Multidrug-resistant Bacteria Within Intensive Care Units

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S207-S208
Author(s):  
Matthew J Ziegler ◽  
Brendan Kelly ◽  
Michael Z David ◽  
Lauren Dutcher ◽  
Pam C Tolomeo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multiple Time ◽  
Extended Spectrum Beta Lactamase ◽  
Environmental Transmission ◽  
Body Culture ◽  
Clinical Culture ◽  
Multiple Time Points

Abstract Background Identifying risk factors for environmental contamination with multidrug-resistant organisms (MDROs) is essential to prioritize methods for prevention of hospital transmission. Methods Patients admitted to an ICU with an MDRO detected on clinical culture in the prior 30 days were enrolled. Patients (4 body sites) and high-touch objects (HTO) (3 composite sites) in ICU rooms were sampled. Environmental transmission was defined by shared MDRO species cultured on patient and HTO cultures obtained on multiple time points during the patient’s stay. Risk factors for environmental transmission were identified with logistic regression. Results Forty-five patients were included (median 2 days of longitudinal sampling [IQR 1–4 days]). Enrollment anatomic cultures included extended-spectrum beta-lactamase-producing Enterobacterales (ESBLE) (n=12, 27%), carbapenem-resistant organisms (CRO) (n=4, 9%), methicillin-resistant S.aureus (MRSA) (n=11, 24%), vancomycin-resistant Enterococci (VRE) (n=4, 9%), and C.difficile (CDIFF) (n=14, 31%). Patient colonization during serial sampling was common with CRO (n=21, 47%), ESBLE (n=16, 36%), and VRE (n=16, 36%) and less so with MRSA (n=7, 16%) and CDIFF (n=5, 11%). Detection of MDROs on environmental surfaces was also common with identification of CRO in 47% of patient rooms (n=21) and ESBLE in 29% (n=13); MRSA (n=2, 4%), VRE (n=9, 20%), and CDIFF (n=3, 7%) were rarer. Patient to environment transmission was observed in 40% of rooms (n=18). Thirteen (29%) rooms had foreign MDRO contamination (i.e., one not detected on a body culture), most (n=10) with CRO. Environmental MDROs were most common in bathroom/sinks (n=22), followed by surfaces near the patient (n=10), and least common surfaces often touched by staff within the room (n=6). On multivariable logistic regression, naïve to clustering by patient, recent receipt of a proton pump inhibitor (OR 2.35, 95% CI 1.00 – 5.52, P=0.049) and presence of one or more wounds (OR 2.56, 95% CI 1.05 – 6.26, P=0.038) were significantly associated with environmental transmission (OR 1.56, 95% CI 1.01 – 2.43, P=0.046) (Table 1). Conclusion MDRO contamination of patient rooms is common with detection of organisms attributed to, and foreign to, the occupant. Disclosures Michael Z. David, MD PhD, GSK (Consultant)

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p < 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p < 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Independent Behavior of Commensal Flora for Carriage of Fluoroquinolone-Resistant Bacteria in Patients at Admission

2010 ◽  
Vol 54 (12) ◽  
pp. 5193-5200 ◽  
Author(s):  
Victoire de Lastours ◽  
Françoise Chau ◽  
Florence Tubach ◽  
Blandine Pasquet ◽  
Etienne Ruppé ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bacterial Resistance ◽  
Care Facility ◽  
Health Care Facility ◽  
Epidemiological Data ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
E Coli ◽  
Commensal Flora ◽  
Resistant Strains

ABSTRACT The important role of commensal flora as a natural reservoir of bacterial resistance is now well established. However, whether the behavior of each commensal flora is similar to that of other floras in terms of rates of carriage and risk factors for bacterial resistance is unknown. During a 6-month period, we prospectively investigated colonization with fluoroquinolone-resistant bacteria in the three main commensal floras from hospitalized patients at admission, targeting Escherichia coli in the fecal flora, coagulase-negative Staphylococcus (CNS) in the nasal flora, and α-hemolytic streptococci in the pharyngeal flora. Resistant strains were detected on quinolone-containing selective agar. Clinical and epidemiological data were collected. A total of 555 patients were included. Carriage rates of resistance were 8.0% in E. coli, 30.3% in CNS for ciprofloxacin, and 27.2% in streptococci for levofloxacin; 56% of the patients carried resistance in at least one flora but only 0.9% simultaneously in all floras, which is no more than random. Risk factors associated with the carriage of fluoroquinolone-resistant strains differed between fecal E. coli (i.e., colonization by multidrug-resistant bacteria) and nasal CNS (i.e., age, coming from a health care facility, and previous antibiotic treatment with a fluoroquinolone) while no risk factors were identified for pharyngeal streptococci. Despite high rates of colonization with fluoroquinolone-resistant bacteria, each commensal flora behaved independently since simultaneous carriage of resistance in the three distinct floras was uncommon, and risk factors differed. Consequences of environmental selective pressures vary in each commensal flora according to its local specificities (clinical trial NCT00520715 [http://clinicaltrials.gov/ct2/show/NCT00520715 ]).

Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients

2021 ◽  
Vol 74 (suppl 6) ◽  
Author(s):  
Monica Taminato ◽  
Richarlisson Borges de Morais ◽  
Dayana Souza Fram ◽  
Rogério Rodrigues Floriano Pereira ◽  
Cibele Grothe Esmanhoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Kidney Transplant ◽  
Multidrug Resistant ◽  
Morbidity And Mortality ◽  
Epidemiological Surveillance ◽  
Resistant Bacteria ◽  
Transplant Recipients ◽  
Kidney Transplant Recipients ◽  
Tract Infections

ABSTRACT Objectives: to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. Methods: a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. Results: ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. Conclusions: colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.

scholarly journals Multidrug-resistant bacteria isolated from patients hospitalized in Intensive Care Unit in University Hospital of Constantine, Algeria (2011 - 2015)

2016 ◽  
Vol 10 (33) ◽  
pp. 1328-1336 ◽  
Author(s):  
Hecini-Hannachi Abla ◽  
Bentchouala Chafia ◽  
Lezzar Abdesselam ◽  
Laouar Houcine ◽  
Benlabed Kaddour ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals Comparison of HRM analysis and three REP-PCR genomic fingerprint methods for rapid typing of MRSA at a Brazilian hospital

2016 ◽  
Vol 10 (12) ◽  
pp. 1306-1317 ◽  
Author(s):  
Giovana Carolina Bodnar ◽  
Heloísa Moreira Martins ◽  
Caio Ferreira De Oliveira ◽  
Alexandre Tadachi Morey ◽  
Eliandro Reis Tavares ◽  
...  
Keyword(s):  
Sccmec Type ◽  
Production Capacity ◽  
Epidemiological Studies ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Resistant Bacteria ◽  
Polymorphism Analysis ◽  
Hrm Analysis ◽  
Type Iv ◽  
Mrsa Strains

Introduction: Infections caused by multidrug-resistant bacteria are increasingly common and represent a serious problem for public health. Staphylococcus aureus is one of the major agents of infections, and methicillin-resistant S. aureus (MRSA) has spread worldwide. The aim of this study was to phenotypically and genotypically characterize 55 MRSAs isolated in the University Hospital of Londrina, Paraná, Brazil, during 2010. Methodology: Bacterial isolates were characterized based on their antimicrobial susceptibility profile, biofilm production capacity, and staphylococcal chromosome cassette mec (SCCmec) type. Determination of clonal groups was performed by polymerase chain reaction using the RW3A, JB1, and BOX A1R primers and high-resolution melting (HRM) analysis. Results: The majority of isolates harbored SCCmec type II. SCCmec III, characteristic of the Brazilian endemic clone, was observed in four strains. Only two isolates harbored SCCmec type IV, which is common in community-acquired MRSA strains. Most isolates also showed resistance to more than four of the tested antimicrobials, and 30 isolates exhibited the ability to produce biofilm. DNA polymorphism analysis showed a higher discriminatory power for the JB1 primer, but RW3A revealed several clonal groups of MRSA with similar genotypic and phenotypic characteristics. HRM analysis showed eight different sequence types. Conclusions: These results are important for epidemiological studies involving MRSA infections.

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