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VIM-positive Pseudomonas aeruginosa in a large tertiary care hospital: matched case-control studies and a network
Anne F Voor In 't Holt1, Juliëtte A Severin1, Margot B H Hagenaars1
11Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
Background:
Emergence of multidrug-resistant Pseudomonas aeruginosa is of global concern. We aimed to identify epidemiological relationships, the most common way of transmission, and risk factors for presence of Verona Integron-encoded Metallo-β-lactamase (VIM)-positive P. aeruginosa (VIM-PA).
Methods:
We conducted a network analysis and matched case-control studies (1:2:2). Controls were hospital-based and matched with cases for ward, day of admission (control group 1 and 2) and time between admission and the identification of VIM-PA (control group 1). The network was visualized using Cytoscape, and risk factors were determined using conditional logistic regression.
Results:
Between August 2003 and April 2015, 144 case patients and 576 control patients were recruited. We identified 307 relationships in 114 out of these 144 patients, with most relationships (84.7%) identified at the same department < 3 months after a previous case patient was discharged. In the multivariable model, having undergone ≥1 gastroscopy (odds ratio [OR] = 4.40, 95% confidence interval [CI] = 2.00 to 9.65 and OR = 2.47; 95% CI = 1.12 to 5.49), > 10 day use of selective digestive tract decontamination (SDD) (OR = 2.97; 95% CI = 1.02 to 8.68 and OR = 4.61; 95% CI = 1.22 to 17.37), and use of quinolones (OR = 3.29; 95% CI = 1.34 to 8.10 and OR = 3.95; 95% CI = 1.13 to 13.83 and OR = 4.47; 95% CI = 1.75 to 11.43) were identified as risk factors when using both control groups.
Conclusions:
The network analysis indicated that the majority of transmissions occurred on the wards, but through unidentified and presumably persistent sources, which are most likely in the innate hospital environment. Previous use of certain antibiotic regimens made patients prone to VIM-PA carriage. Additionally, gastroscopy could be considered as a high-risk procedure in patients with risk factors. Our results add to the growing body of evidence that infection control measures targeting VIM-PA should be focused on reducing antibiotics and eliminating sources in the environment.
Insights
Multidrug-resistant Pseudomonas aeruginosa, specifically Verona Integron-encoded Metallo-β-lactamase-positive strains (VIM-PA), often spread within hospitals through environmental sources. Reducing antibiotic use and environmental contamination are key to controlling VIM-PA transmission.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Epidemiology
Background:
- The emergence of multidrug-resistant Pseudomonas aeruginosa, particularly Verona Integron-encoded Metallo-β-lactamase (VIM)-positive strains (VIM-PA), poses a significant global health threat.
- Understanding the transmission dynamics and risk factors associated with VIM-PA is crucial for developing effective control strategies in healthcare settings.
Purpose of the Study:
- To identify epidemiological relationships and common transmission routes of VIM-PA within a hospital environment.
- To determine specific risk factors associated with the presence of VIM-PA in patients.
Main Methods:
- Network analysis was employed to visualize and analyze patient relationships and potential transmission pathways.
- Matched case-control studies (1:2:2) were conducted to identify risk factors, with controls matched for ward, admission day, and time to VIM-PA identification.
- Conditional logistic regression was used to determine risk factors, and Cytoscape software visualized the network.
Main Results:
- Network analysis revealed that 84.7% of VIM-PA transmissions occurred within the same hospital department within three months.
- Significant risk factors for VIM-PA presence included undergoing gastroscopy (OR=4.40), prolonged use (>10 days) of selective digestive tract decontamination (SDD) (OR=2.97), and quinolone antibiotic use (OR=3.29).
- These risk factors remained significant when analyzed against both control groups.
Conclusions:
- Transmission of VIM-PA primarily occurs on hospital wards, likely from unidentified, persistent environmental sources.
- Prior exposure to specific antibiotic regimens, including quinolones and SDD, increases patient susceptibility to VIM-PA.
- Gastroscopy is identified as a high-risk procedure for patients with pre-existing risk factors, necessitating targeted infection control measures focusing on antibiotic stewardship and environmental disinfection.
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