Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients
M E Villarino1, L E Stevens, B Schable
1National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
Objective:
To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.
Design:
Surveillance and cohort study.
Setting:
A 470-bed tertiary trauma-referral community hospital.
Patients:
From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization greater than or equal to 48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for greater than or equal to 72 hours during the epidemic period who had no X maltophilia-positive culture).
Results:
Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk = 1.3, p = .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient's room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel's hands. Related environmental and clinical isolates were serotype 10.
Conclusions:
Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.
Insights
Patients requiring mechanical ventilation and antimicrobials in the shock-trauma ICU face higher risks of Xanthomonas maltophilia infection. Surgical wound infections can act as reservoirs, leading to transmission via contaminated equipment and personnel.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Xanthomonas maltophilia (Xm) poses a significant threat in healthcare settings, particularly to critically ill patients.
- Understanding transmission routes and risk factors is crucial for infection control in intensive care units (ICUs).
Purpose of the Study:
- To identify risk factors associated with Xanthomonas maltophilia infection and colonization.
- To elucidate the modes of transmission for Xm within a hospital environment.
Main Methods:
- A surveillance and cohort study was conducted in a 470-bed tertiary trauma-referral community hospital.
- Case patients (n=45) were defined as ICU patients with Xm infection/colonization >48 hours post-admission during an epidemic period.
- Control patients (n=103) were ICU patients without Xm-positive cultures.
Main Results:
- The shock-trauma ICU had a higher incidence of Xm infection/colonization compared to other ICUs.
- Mechanical ventilation, tracheostomy, air transport, and multiple antimicrobial agents were identified as risk factors.
- Exposure to patients with Xm surgical wound infections increased risk (RR=1.3, p=.03).
- Xm contamination was found on respiratory equipment, shared respirometers, and personnel hands, linked to surgical wound infections.
Conclusions:
- Mechanically ventilated patients receiving antimicrobials in the shock-trauma ICU are at elevated risk for Xm infection/colonization.
- Patients with draining Xm surgical wound infections act as reservoirs for transmission.
- Contaminated respirometers and healthcare worker hands facilitate patient-to-patient spread of Xm.
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