Infection Prevention in Practice最新文献_第2页

Intrahospital dissemination of multidrug-resistant Acinetobacter baumannii at a teaching hospital in Northeast of Mexico

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-01-25 DOI: 10.1016/j.infpip.2025.100443

Samantha Villarreal-Cruz , Adrián Camacho-Ortiz , Samantha Flores-Treviño , Licet Villarreal-Treviño , Paola Bocanegra-Ibarias

Background

Acinetobacter baumannii is an opportunistic drug-resistant Gram-negative coccobacillus associated with nosocomial infections, representing a worldwide public health problem.

Aim

The aim of this study was to analyse the dissemination of A. baumannii in two hospital buildings in Mexico through phenotypic and genotypic characterization of clinical isolates obtained for three years.

Methods

Clinical strains were collected from two buildings in a tertiary-care hospital in Monterrey, Mexico. After species identification by MALDI-TOF MS and PCR, antimicrobial susceptibility was determined by disk diffusion and microdilution methods, carbapenemase-encoding genes (OXA-23, -24, -51, and -58) were searched, and clonal diversity was analysed by PFGE and MLST.

Findings

Among 204 specimens, 87.3% and 50.5% of the isolates were classified as multidrug-resistant (MDR) and difficult-to-treat-resistant (DTR), respectively. The OXA-24 gene was detected in 95% of the isolates. Most isolates (n=181) were grouped into 15 clones, four which predominated and disseminated after five months. Among ST detected (ST1694, ST758, ST124, and ST490), ST124, which belongs to the high-risk CC636 clonal complex, is reported for the first time in Mexico.

Conclusions

Long-term persistence and dissemination of A. baumannii clones were observed in specific hospital wards from two buildings in a tertiary-care hospital in Mexico. High antimicrobial resistance, such as MDR and DTR, were observed in this hospital. DTR surveillance and early recognition of MDR A. baumannii clones should be performed routinely to prevent their dissemination.

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引用次数: 0

Clinical and economic impact of ventilator-associated pneumonia in intensive care units in Japan

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-01-21 DOI: 10.1016/j.infpip.2025.100440

Taikan Nanao , Koichi Benjamin Ishikawa , Shunya Ikeda , Tsutomu Yamazaki

Ventilator-associated pneumonia (VAP) has a considerable impact on both clinical outcomes and healthcare costs. This study compared 40 patients having VAP with 40 matched controls from a Japanese ICU dataset. Patients with VAP experienced significantly longer ICU and hospital stays, fewer ventilator-free days, and a higher incidence of tracheostomies. VAP cases also required more broad-spectrum antimicrobials, leading to an additional cost of approximately USD 24,410 per case. These results highlight the importance of implementing effective infection control strategies to mitigate VAP's clinical and economic consequences.

引用次数: 0

Healthcare professionals' knowledge, attitudes, and practices in preventing catheter-associated urinary tract infections: a cross-sectional study in a rehabilitation facility

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-01-18 DOI: 10.1016/j.infpip.2025.100438

D.C. Muscat , M. Sciortino , E. Tartari

Background

Catheter-associated urinary tract infections (CAUTIs) are prevalent yet preventable healthcare-associated infections. Effective prevention requires healthcare professionals (HCPs) to possess adequate knowledge, positive attitudes, and adherence to best practices.

Objective

To evaluate the knowledge, attitudes, and practices (KAPs) of HCPs regarding the prevention and management of CAUTI in a Maltese rehabilitation facility.

Methods

A cross-sectional survey was conducted with a self-administered online questionnaire from January to March 2023, using total population sampling of doctors, nurses, and nursing assistants (N = 315). Descriptive and inferential analyses were conducted using SPSS.

Results

Of the 315 HCPs invited, 215 responded (68.3%). KAP levels towards CAUTI prevention were moderate to adequate. The attitude scores of doctors and nurses varied significantly based on nationality (P = 0.011), professional designation (P = 0.010), and educational level (P<0.001). Positive correlations were identified between CAUTI knowledge and practices among doctors' and nurses' (P=0.002, r = 0.309). For nursing assistants, significant differences were observed across knowledge (P<0.001), attitude (P<0.001), and practice scores (P<0.001), based on age, educational level, job experience, and timing of their last infection prevention and control training. Positive correlations were observed between knowledge and attitudes (P<0.001, r = 0.471), knowledge and practice (P<0.001, r = 0.383), and attitudes and practice (P<0.001, r = 0.403) for nursing assistants.

Conclusions

HCP knowledge and attitudes directly influence CAUTI prevention practices. Continuous education and targeted training programmes are critical to improving practices and reducing CAUTI-related patient harm.

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引用次数: 0

Surgical prophylaxis in Haydom Lutheran Hospital, Tanzania – learning from a point prevalence survey

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-01-09 DOI: 10.1016/j.infpip.2024.100429

T.J. Schrama , K.J. Vliegenthart-Jongbloed , M. Gemuwang , E.Q. Nuwass

Background

Antimicrobial resistance (AMR) is a significant global health concern, with improper antibiotic use contributing to its rise. Tanzania initiated an AMR action plan in 2017, but comprehensive surveillance and stewardship efforts remain limited. This study focused on evaluating antibiotic use, particularly surgical prophylaxis, in a rural Tanzanian hospital.

Methods

The study was conducted at Haydom Lutheran Hospital in Tanzania in May 2023, using a cross-sectional point prevalence survey. Antibiotic use in all patients admitted for >24 h and those undergoing surgery was recorded, including type, dose, indication and duration. Quality indicators for surgical prophylaxis were assessed.

Results

Among 199 inpatients, 55% received antibiotics, with surgical prophylaxis accounting for 23% of prescriptions. Notably, none of the patients who received surgical prophylaxis received a single-dose regimen, and 67% exceeded the recommended 24-h duration. A combination of ampicillin-cloxacillin plus metronidazole was the most commonly prescribed combination for surgical prophylaxis (41% of prescriptions). Thirty-three percent of the antibiotics prescribed for surgical prophylaxis were classified as ‘Not recommended’ by the World Health Organization. Furthermore, 90% of surgical prophylaxis prescriptions lacked documented rationale, and 83% of prescriptions lacked stop/review dates in medical records.

Conclusion

This study reveals a high prevalence of prolonged antibiotic use for surgical prophylaxis, frequent use of antibiotics classified as ‘Not recommended’, and a lack of adequate documentation, which deviates from international standards. These practices highlight the urgent need for contextualized national guidelines, large-scale implementation projects of evidence-based interventions, and local initiatives in antibiotic stewardship, particularly in low-resource settings.

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引用次数: 0

Reducing waste and improving provider safety: a retrospective analysis with lessons from the COVID-19 Pandemic

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-01-08 DOI: 10.1016/j.infpip.2025.100437

Johannes Heymer, Stefani Fruchi, Anna Hein, Matthias Ott, Daniel Räpple

Background

Reducing waste is an important component in comprehensive efforts to create greener intensive care units (ICU). Personal protective equipment (PPE) constitutes a significant share of the waste produced during ICU care. During the COVID-19 pandemic, the availability and supply of PPE posed substantial challenges globally. We aimed to investigate the lessons learned from the use of PPE during the pandemic (regarding the reduction of PPE consumption) and impact on hospital-acquired infections in healthcare workers.

Methods

Conducting a retrospective analysis, we examined all newly issued standard operating procedures for the ICU related to the pandemic. We observed for a potential effect on the use of PPE and scrutinized PPE consumption and patient day data focusing on potential differences between 2020 and the following years until 2023. The primary objective was to evaluate the impact of the protocols and measures on PPE consumption.

Results

Our analysis revealed that the implementation of four key infection control measures (cohorting, limitation of visits, institutional protocols for PPE use, staff training) lead to a substantial reduction in the use of masks and isolation gowns during the initial stages of the COVID-19 pandemic with no recorded hospital-acquired infections among healthcare workers.

Conclusion

It is possible to reduce PPE consumption without compromising the safety of our healthcare professionals. Our observations may guide future policies to reduce PPE consumption with the intent of reducing the environmental impact.

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引用次数: 0

Understanding healthcare workers' experiences of face mask use in healthcare settings during the COVID-19 pandemic: an interview study

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-01-06 DOI: 10.1016/j.infpip.2024.100434

H. Carter , A. Sharp , L. Davidson , C. Foster , E. McGuire , C. Brown , D. Weston

Background

Whilst healthcare workers (HCWs) are at high risk of contracting infectious viral diseases, such as COVID-19, measures can be put in place to reduce the spread of diseases in healthcare settings. These currently include the use of different types of masks: fluid-resistant surgical masks (FRSM) and filtering facepiece (FFP3) respirators. However, for mask policies to be effective, compliance with their use must be high.

Aim

To understand any barriers to face mask use, and to promote compliance with face mask policy.

Methods

Twelve HCWs from a variety of backgrounds were interviewed during the COVID-19 pandemic in England in 2022 to understand their experiences of mask use. We explored factors associated with compliance with mask use and potential impacts on HCW wellbeing.

Findings

Overall, participants reported good understanding of the benefits of masks and high compliance levels with policy. However, factors that reduced their compliance with mask policy and impacted their ability to carry out their role were highlighted. These included wearing masks for longer durations, policy being perceived as out of proportion with risk, communication challenges, and discomfort.

Conclusion

This study highlights the importance of clear communication of guidance, particularly when it has changed, ensuring staff are familiar with up-to-date research on efficacy of masks, and ensuring guidance aligns with risk. Furthermore, this study highlights the importance of masks being required for an appropriate duration (based on risk).

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引用次数: 0

Concurrent presence of Staphylococcal Cassette Chromosome mec types of Meticillin-Resistant Staphylococcus aureus in hospital environments and post-operative patients at a hospital in Kathmandu, Nepal

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-28 DOI: 10.1016/j.infpip.2024.100436

Krishma Pandit , Supriya Sharma , Shreedhar Aryal , Asmita Lamichhane , Sushma Regmi , Prativa Paudel , Sirjana Koirala , Suprina Sharma , Sanjib Adhikari , Komal Raj Rijal , Pramod Poudel

Introduction

Meticillin resistant S. aureus (MRSA) is a major contributor to surgical site infections in post-operative patients. Hospital environments harbor MRSA, contributing to higher risk of nosocomial infections. Meticillin resistance is conferred by acquisition of mecA gene, typically carried on mobile genetic element called Staphylococcal Cassette Chromosome mec (SCCmec).

Objective

This study aimed to determine the prevalence of MRSA, detect mecA, characterize SCCmec types and compare their concurrent presence in clinical and environmental isolates.

Methods

A cross sectional study was conducted at Bhaktapur Hospital, Nepal among clinical specimens collected from postoperative patients. Air and environmental samples were collected by plate exposure and swabbing methods. Samples were processed for culture and antibiotic susceptibility testing by Kirby-Bauer Disc diffusion method, and identification of MRSA using cefoxitin disc. SCCmec typing was done by conventional PCR.

Results

The culture positivity among samples from post-operative patients was 13.9% (326/2350) with S.aureus (39.7%,29/73) being predominating Gram positive bacteria. MRSA accounted for 68 % (20/29) of clinical isolates and 66% (22/33) of environmental isolates, with mecA detected in 85% (17/20) and 72.8% (16/22) respectively. SCCmec Type II predominated followed by Type V and I, while other types were absent. Comparison of SCCmec elements between post-operative patients and hospital environmental samples revealed concurrent presence in both setting, with Type II being the most prevalent.

Conclusions

SCCmec Type I, II, V and mecA elements were concurrently present in both post-operative patients and hospital environments. Effective preventive measures are warranted to break the MRSA transmission between these settings.

导言：耐甲氧西林金黄色葡萄球菌（MRSA）是造成术后患者手术部位感染的主要因素。医院环境容易滋生 MRSA，导致院内感染的风险更高。梅迪西林耐药性是通过获得 mecA 基因而产生的，该基因通常携带在称为葡萄球菌盒式染色体 mec（SCCmec）的移动遗传元件上：本研究旨在确定 MRSA 的流行率、检测 mecA、描述 SCCmec 类型并比较它们在临床和环境分离物中的同时存在情况：在尼泊尔巴克塔普尔医院对术后患者的临床标本进行了横断面研究。采用平板暴露法和拭子法收集空气和环境样本。样本经处理后进行培养，采用柯比鲍尔盘扩散法进行抗生素药敏试验，并使用头孢西丁盘鉴定 MRSA。SCCmec 分型采用传统的 PCR 方法进行：术后患者样本培养阳性率为 13.9%（326/2350），其中金黄色葡萄球菌（39.7%，29/73）是主要的革兰氏阳性菌。MRSA 在临床分离菌中占 68%（20/29），在环境分离菌中占 66%（22/33），分别在 85%（17/20）和 72.8%（16/22）的环境分离菌中检测到 mecA。SCCmec 类型以 II 型为主，其次是 V 型和 I 型，其他类型不存在。对比术后患者和医院环境样本中的SCCmec元素发现，这两种环境中都同时存在SCCmec，其中以II型最为普遍：结论：SCCmec I型、II型、V型和mecA元素同时存在于术后患者和医院环境中。需要采取有效的预防措施来阻止 MRSA 在这些环境中的传播。

{"title":"Concurrent presence of Staphylococcal Cassette Chromosome mec types of Meticillin-Resistant Staphylococcus aureus in hospital environments and post-operative patients at a hospital in Kathmandu, Nepal","authors":"Krishma Pandit , Supriya Sharma , Shreedhar Aryal , Asmita Lamichhane , Sushma Regmi , Prativa Paudel , Sirjana Koirala , Suprina Sharma , Sanjib Adhikari , Komal Raj Rijal , Pramod Poudel","doi":"10.1016/j.infpip.2024.100436","DOIUrl":"10.1016/j.infpip.2024.100436","url":null,"abstract":"<div><h3>Introduction</h3><div>Meticillin resistant <em>S. aureus</em> (MRSA) is a major contributor to surgical site infections in post-operative patients. Hospital environments harbor MRSA, contributing to higher risk of nosocomial infections. Meticillin resistance is conferred by acquisition of <em>mecA</em> gene, typically carried on mobile genetic element called Staphylococcal Cassette Chromosome <em>mec</em> (SCC<em>mec</em>).</div></div><div><h3>Objective</h3><div>This study aimed to determine the prevalence of MRSA, detect <em>mecA</em>, characterize SCC<em>mec</em> types and compare their concurrent presence in clinical and environmental isolates.</div></div><div><h3>Methods</h3><div>A cross sectional study was conducted at Bhaktapur Hospital, Nepal among clinical specimens collected from postoperative patients. Air and environmental samples were collected by plate exposure and swabbing methods. Samples were processed for culture and antibiotic susceptibility testing by Kirby-Bauer Disc diffusion method, and identification of MRSA using cefoxitin disc. SCC<em>mec</em> typing was done by conventional PCR.</div></div><div><h3>Results</h3><div>The culture positivity among samples from post-operative patients was 13.9% (326/2350) with <em>S.aureus</em> (39.7%,29/73) being predominating Gram positive bacteria. MRSA accounted for 68 % (20/29) of clinical isolates and 66% (22/33) of environmental isolates, with <em>mecA</em> detected in 85% (17/20) and 72.8% (16/22) respectively. SCC<em>mec</em> Type II predominated followed by Type V and I, while other types were absent. Comparison of SCC<em>mec</em> elements between post-operative patients and hospital environmental samples revealed concurrent presence in both setting, with Type II being the most prevalent.</div></div><div><h3>Conclusions</h3><div>SCC<em>mec</em> Type I, II, V and <em>mecA</em> elements were concurrently present in both post-operative patients and hospital environments. Effective preventive measures are warranted to break the MRSA transmission between these settings.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100436"},"PeriodicalIF":1.8,"publicationDate":"2024-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774771/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Risk of nosocomial respiratory syncytial virus versus influenza among adult patients in acute care hospitals

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-26 DOI: 10.1016/j.infpip.2024.100431

Raija Auvinen , Kaisa Huotari , Hanna Nohynek , Ritva K. Syrjänen , Kirsi Skogberg

Background

While nosocomial influenza is common, the risk of transmission in acute care remains unclear in the absence of systematic surveillance. Even less is known about the risk of nosocomial respiratory syncytial virus (RSV) among immunocompetent adults.

Aim

To compare the proportions and incidences of nosocomial cases caused by these two similar respiratory infections among hospitalized adults.

Methods

A retrospective study was conducted at two tertiary care hospitals in Southern Finland. Data on all hospitalized adult patients with a positive RSV or influenza test during 2016–22 were used to detect all nosocomial and community-acquired RSV and influenza cases. The proportion of nosocomial cases of all hospitalized cases was calculated. The incidences of nosocomial cases per 1000 bed-days were calculated by season and ward type for the five seasons before the COVID-19 pandemic.

Results

Nosocomial RSV and influenza occurred in 2.8% and 8.1% of all hospitalized adult patients with a laboratory-confirmed infection. Over five seasons, 2016–20, the total incidences of nosocomial RSV and influenza cases per 1000 bed-days were 0.027 (95% confidence interval: 0.013, 0.050) and 0.32 (0.27, 0.39). Nosocomial RSV infections were especially poorly recorded with a virus-specific ICD-10 diagnosis code listed for only 16.7% of RSV and 59.8% of nosocomial influenza patients.

Conclusion

Despite preventive measures, the incidence of nosocomial influenza was more than tenfold, and the proportion of nosocomial cases was almost threefold compared with RSV among hospitalized adults in acute care. Prevention and surveillance of both nosocomial influenza and RSV should be improved also among immunocompetent adult patients.

{"title":"Risk of nosocomial respiratory syncytial virus versus influenza among adult patients in acute care hospitals","authors":"Raija Auvinen , Kaisa Huotari , Hanna Nohynek , Ritva K. Syrjänen , Kirsi Skogberg","doi":"10.1016/j.infpip.2024.100431","DOIUrl":"10.1016/j.infpip.2024.100431","url":null,"abstract":"<div><h3>Background</h3><div>While nosocomial influenza is common, the risk of transmission in acute care remains unclear in the absence of systematic surveillance. Even less is known about the risk of nosocomial respiratory syncytial virus (RSV) among immunocompetent adults.</div></div><div><h3>Aim</h3><div>To compare the proportions and incidences of nosocomial cases caused by these two similar respiratory infections among hospitalized adults.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at two tertiary care hospitals in Southern Finland. Data on all hospitalized adult patients with a positive RSV or influenza test during 2016–22 were used to detect all nosocomial and community-acquired RSV and influenza cases. The proportion of nosocomial cases of all hospitalized cases was calculated. The incidences of nosocomial cases per 1000 bed-days were calculated by season and ward type for the five seasons before the COVID-19 pandemic.</div></div><div><h3>Results</h3><div>Nosocomial RSV and influenza occurred in 2.8% and 8.1% of all hospitalized adult patients with a laboratory-confirmed infection. Over five seasons, 2016–20, the total incidences of nosocomial RSV and influenza cases per 1000 bed-days were 0.027 (95% confidence interval: 0.013, 0.050) and 0.32 (0.27, 0.39). Nosocomial RSV infections were especially poorly recorded with a virus-specific ICD-10 diagnosis code listed for only 16.7% of RSV and 59.8% of nosocomial influenza patients.</div></div><div><h3>Conclusion</h3><div>Despite preventive measures, the incidence of nosocomial influenza was more than tenfold, and the proportion of nosocomial cases was almost threefold compared with RSV among hospitalized adults in acute care. Prevention and surveillance of both nosocomial influenza and RSV should be improved also among immunocompetent adult patients.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100431"},"PeriodicalIF":1.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11782808/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Genomic evaluation of phenotypic antibiotic susceptibility patterns as a surrogate for MRSA relatedness and putative transmission during outbreak investigations

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-26 DOI: 10.1016/j.infpip.2024.100435

Francesc Coll , Michelle S. Toleman , Ewan M. Harrison , Beth Blane , Dorota Jamrozy , Nicholas M. Brown , Julian Parkhill , Sharon J. Peacock

Antibiograms have been used during outbreak investigations for decades as a surrogate for genetic relatedness of Methicillin-resistant Staphylococcus aureus (MRSA). In this study, we evaluate the accuracy of antibiograms in detecting transmission, using genomic epidemiology as the reference standard. We analysed epidemiological and genomic data from 1,465 patients and 1,465 MRSA isolates collected at a single clinical microbiology laboratory in the United Kingdom over a one-year period. A total of 132 unique antibiograms (AB) were identified based on VITEK 2 susceptibility testing, with two profiles (AB1 and AB2) accounting for 698 isolates (48%). We identified MRSA-positive patients with a known hospital or community contact and evaluated the prediction of MRSA transmission based on identical antibiograms. The sensitivity and specificity of identical antibiograms to infer genetically related MRSA isolates (≤25 SNPs) within hospital contacts (presumed transmission events) was 66.4% and 85.5% respectively and 73.8% and 85.7% within community contacts. Reanalysis, where any single drug mismatch in susceptibility results was allowed, increased sensitivity but reduced specificity: 95.2% and 58.8%, respectively, for hospital contacts; and 91.7% and 62.6% for community contacts. Overall, the sensitivity and specificity of identical antibiograms for inferring genetically related MRSA isolates (≤25 SNPs), regardless of epidemiological links, were 49.1% and 87.5%, respectively. We conclude that using an antibiogram with one mismatch can detect most transmission events; however, its poor specificity may lead to an increased workload through the evaluation of numerous pseudo-outbreaks. This study further supports the integration of genomic epidemiology into routine practice for the detection and control of MRSA transmission.

{"title":"Genomic evaluation of phenotypic antibiotic susceptibility patterns as a surrogate for MRSA relatedness and putative transmission during outbreak investigations","authors":"Francesc Coll , Michelle S. Toleman , Ewan M. Harrison , Beth Blane , Dorota Jamrozy , Nicholas M. Brown , Julian Parkhill , Sharon J. Peacock","doi":"10.1016/j.infpip.2024.100435","DOIUrl":"10.1016/j.infpip.2024.100435","url":null,"abstract":"<div><div>Antibiograms have been used during outbreak investigations for decades as a surrogate for genetic relatedness of Methicillin-resistant <em>Staphylococcus aureus</em> (MRSA). In this study, we evaluate the accuracy of antibiograms in detecting transmission, using genomic epidemiology as the reference standard. We analysed epidemiological and genomic data from 1,465 patients and 1,465 MRSA isolates collected at a single clinical microbiology laboratory in the United Kingdom over a one-year period. A total of 132 unique antibiograms (AB) were identified based on VITEK 2 susceptibility testing, with two profiles (AB1 and AB2) accounting for 698 isolates (48%). We identified MRSA-positive patients with a known hospital or community contact and evaluated the prediction of MRSA transmission based on identical antibiograms. The sensitivity and specificity of identical antibiograms to infer genetically related MRSA isolates (≤25 SNPs) within hospital contacts (presumed transmission events) was 66.4% and 85.5% respectively and 73.8% and 85.7% within community contacts. Reanalysis, where any single drug mismatch in susceptibility results was allowed, increased sensitivity but reduced specificity: 95.2% and 58.8%, respectively, for hospital contacts; and 91.7% and 62.6% for community contacts. Overall, the sensitivity and specificity of identical antibiograms for inferring genetically related MRSA isolates (≤25 SNPs), regardless of epidemiological links, were 49.1% and 87.5%, respectively. We conclude that using an antibiogram with one mismatch can detect most transmission events; however, its poor specificity may lead to an increased workload through the evaluation of numerous pseudo-outbreaks. This study further supports the integration of genomic epidemiology into routine practice for the detection and control of MRSA transmission.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100435"},"PeriodicalIF":1.8,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11772957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Hospital toilets and drainage systems as a reservoir for a long-term polyclonal outbreak of clinical infections with multidrug-resistant Klebsiella oxytoca species complex

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-21 DOI: 10.1016/j.infpip.2024.100430

Astri Lervik Larsen , Torunn Pedersen , Arnfinn Sundsfjord , Theodor A. Ross , Anja Dyresen Guleng , Jon Birger Haug , Anna K. Pöntinen , Ørjan Samuelsen

Background

Nosocomial outbreaks with multidrug-resistant bacteria with a probable reservoir in hospital toilets and drainage systems have been increasingly reported.

Aim

To investigate an increase in bacteraemia with extended-spectrum β-lactamase (ESBL)-producing Klebsiella oxytoca at our hospital in 2021; the epidemiology of the outbreak suggested an environmental source.

Methods

Available clinical K. oxytoca isolates from patient with infection or rectal carriage from 2019 to 2022 were collected. Clinical information was gathered from included patients and sampled sinks, shower drains, and toilet water. Short- and long-read whole-genome sequencing (WGS) was performed on patient and environmental isolates to assess phylogenetic relationships, antibiotic resistance genes/mutations, and plasmid profiles.

Results

WGS revealed four clusters and a polyclonal population consisting of ESBL-producing K. oxytoca and Klebsiella michiganensis. All clusters contained both clinical and environmental isolates. The environmental sampling revealed widespread contamination of the outbreak strains in the outbreak ward, and plasmid analyses indicated possible transfer of plasmids between species and clones. Most environmental findings in the outbreak ward were from toilet water, and enhanced cleaning of bathrooms and toilets was introduced. The following year, a decrease in outbreak strains in systemic infections was observed.

Conclusion

This investigation uncovered a polyclonal outbreak of multidrug-resistant K. oxytoca and K. michiganensis and unveiled a persistent reservoir of outbreak clones in the drainage system and toilet water, facilitating exchange of resistance genes. The risk of toilet water as a source of clinical infections warrants further investigation.

{"title":"Hospital toilets and drainage systems as a reservoir for a long-term polyclonal outbreak of clinical infections with multidrug-resistant Klebsiella oxytoca species complex","authors":"Astri Lervik Larsen , Torunn Pedersen , Arnfinn Sundsfjord , Theodor A. Ross , Anja Dyresen Guleng , Jon Birger Haug , Anna K. Pöntinen , Ørjan Samuelsen","doi":"10.1016/j.infpip.2024.100430","DOIUrl":"10.1016/j.infpip.2024.100430","url":null,"abstract":"<div><h3>Background</h3><div>Nosocomial outbreaks with multidrug-resistant bacteria with a probable reservoir in hospital toilets and drainage systems have been increasingly reported.</div></div><div><h3>Aim</h3><div>To investigate an increase in bacteraemia with extended-spectrum β-lactamase (ESBL)-producing <em>Klebsiella oxytoca</em> at our hospital in 2021; the epidemiology of the outbreak suggested an environmental source.</div></div><div><h3>Methods</h3><div>Available clinical <em>K. oxytoca</em> isolates from patient with infection or rectal carriage from 2019 to 2022 were collected. Clinical information was gathered from included patients and sampled sinks, shower drains, and toilet water. Short- and long-read whole-genome sequencing (WGS) was performed on patient and environmental isolates to assess phylogenetic relationships, antibiotic resistance genes/mutations, and plasmid profiles.</div></div><div><h3>Results</h3><div>WGS revealed four clusters and a polyclonal population consisting of ESBL-producing <em>K. oxytoca</em> and <em>Klebsiella michiganensis</em>. All clusters contained both clinical and environmental isolates. The environmental sampling revealed widespread contamination of the outbreak strains in the outbreak ward, and plasmid analyses indicated possible transfer of plasmids between species and clones. Most environmental findings in the outbreak ward were from toilet water, and enhanced cleaning of bathrooms and toilets was introduced. The following year, a decrease in outbreak strains in systemic infections was observed.</div></div><div><h3>Conclusion</h3><div>This investigation uncovered a polyclonal outbreak of multidrug-resistant <em>K. oxytoca</em> and <em>K. michiganensis</em> and unveiled a persistent reservoir of outbreak clones in the drainage system and toilet water, facilitating exchange of resistance genes. The risk of toilet water as a source of clinical infections warrants further investigation.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100430"},"PeriodicalIF":1.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0