Improvement of infection control management by routine molecular evaluation of pathogen clusters
Nico T Mutters1, Klaus Heeg1, Isabel Späth1
1Heidelberg University Hospital, Department of Infectious Diseases, Im Neuenheimer Feld 324, D-69120 Heidelberg, Germany.
Background:
Undetected pathogen clusters can often be a source of spreading in-hospital infections. Unfortunately, detection of clusters can be problematic because epidemiological connection is not always easily established. Infection prevention and control (IPC) measures, however, are most effective when applied at the earliest possible stage.
Aim:
The goal of our study was to evaluate the benefits of routine use of molecular typing techniques for IPC management in a large University teaching hospital.
Methods:
We implemented daily routine molecular typing of pathogen clusters using cost-effective standard methods such as random amplified polymorphic DNA PCR, multiple-locus variable number tandem repeat analysis, and spa-typing over a 4-year study period (2012-2015).
Findings:
Four pathogen clusters were evaluated: (I) 14 cases of Clostridium difficile in a peripheral ward, (II) 17 cases of methicillin-resistant Staphylococcus aureus (MRSA) in two intensive-care units (ICUs), (III) 21 cases of multidrug-resistant Klebsiella pneumoniae within one department, and (IV) 6 cases of vancomycin-resistant Enterococcus faecium in an interdisciplinary ICU. Typing revealed that cluster I was not caused by an outbreak strain but was likely due to different endogenous infections. Clusters III and IV showed a classical space-time clustering of point source outbreaks. Cluster II represented a prolonged temporal cluster, which would have gone undetected without molecular typing because of large intercase intervals.
Conclusion:
Implementing daily routine molecular typing is effective for detecting and analyzing pathogen clusters. Falsely suspected outbreaks can be quickly resolved, whereas actual outbreaks can be identified faster, so that targeted IPC measures can be applied earlier.
Insights
Routine molecular typing effectively detects and analyzes pathogen clusters, enabling faster identification of actual outbreaks and quicker implementation of infection prevention and control measures. This approach helps resolve suspected outbreaks efficiently.
Area of Science:
- Medical Microbiology
- Infectious Disease Epidemiology
- Hospital Infection Control
Background:
- Hospital-acquired infections often stem from undetected pathogen clusters.
- Establishing epidemiological connections for cluster detection can be challenging.
- Early intervention through infection prevention and control (IPC) is crucial.
Purpose of the Study:
- To assess the advantages of routine molecular typing for IPC management in a university teaching hospital.
- To evaluate the utility of standard molecular typing methods in a clinical setting.
Main Methods:
- Daily molecular typing of pathogen clusters over four years (2012-2015).
- Utilized cost-effective techniques: random amplified polymorphic DNA PCR, multiple-locus variable number tandem repeat analysis, and spa-typing.
- Investigated four distinct pathogen clusters: Clostridium difficile, MRSA, Klebsiella pneumoniae, and vancomycin-resistant Enterococcus faecium.
Main Results:
- Molecular typing differentiated true outbreaks from non-outbreak events (e.g., endogenous infections).
- Identified classical point-source outbreaks for Klebsiella pneumoniae and vancomycin-resistant Enterococcus faecium.
- Revealed a prolonged temporal cluster of MRSA that would have been missed without molecular typing due to long intervals between cases.
Conclusions:
- Daily routine molecular typing is a valuable tool for detecting and analyzing pathogen clusters.
- Facilitates rapid resolution of suspected outbreaks and earlier identification of confirmed outbreaks.
- Enables timely application of targeted IPC measures, improving patient safety.
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