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Risk factors for the environmental spread of different multidrug-resistant organisms: a prospective cohort study
R Saliba1, T Ghelfenstein-Ferreira2, A Lomont2
1IAME, UMR 1137, Université Sorbonne Paris Nord, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France; Laboratoire des Agents Pathogènes, Saint-Joseph University of Beirut, Beirut, Lebanon.
Background:
Substantial scientific evidence shows that contamination of environmental surfaces in hospitals plays an important role in the transmission of multidrug-resistant organisms (MDROs). To date, studies have failed to identify the risk factors associated with environmental contamination.
Aim:
To evaluate, compare, and identify factors associated with environmental contamination around carriers of different MDROs.
Methods:
This was a prospective cohort study from May 2018 to February 2020. A total of 125 patients were included, having been admitted to Avicenne Hospital and Hotel Dieu de France de Beyrouth Hospital who were faecal carriers of MDROs (extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE)). For each patient, quantification of MDRO in stool was undertaken, plus a qualitative evaluation of the presence of MDRO in six different environmental sites; and clinical data were collected.
Findings:
MDROs comprised ESBL-PE (34%), CPE (45%), and VRE (21%). The most frequent MDRO species was Escherichia coli. Contamination of at least one environmental site was observed for 22 (18%) patients. Only carriage of VanA was associated with a significantly higher risk of dissemination. Having a urinary catheter, carriage of OXA48 and E. coli were protective factors against environmental contamination. There were no significant differences in environmental contamination between E. coli and other Enterobacterales or between ESBL-PE and CPE.
Conclusions:
Hospital environmental contamination rates are substantially higher for patients with VRE, compared to the low environment dissemination rates around ESBL-PE and CPE. Further studies on a larger scale are needed to confirm the validity of our findings.
Insights
Hospital environmental contamination is linked to multidrug-resistant organisms (MDROs). Vancomycin-resistant enterococci (VRE) showed higher dissemination risk, unlike extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenemase-producing Enterobacterales (CPE).
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Hospital Epidemiology
Background:
- Environmental surface contamination in hospitals is a significant factor in multidrug-resistant organism (MDRO) transmission.
- Previous studies have not identified specific risk factors for environmental contamination by MDROs.
Purpose of the Study:
- To investigate and compare factors associated with environmental contamination in patients carrying different types of MDROs.
- To identify specific MDROs and patient characteristics that increase the risk of environmental spread.
Main Methods:
- A prospective cohort study involving 125 patients carrying fecal MDROs (ESBL-PE, CPE, VRE) was conducted from May 2018 to February 2020.
- MDRO quantification in stool and qualitative environmental sampling at six sites were performed.
- Clinical data, including urinary catheter use, were collected for analysis.
Main Results:
- Vancomycin-resistant enterococci (VRE) carriage was significantly associated with a higher risk of environmental dissemination.
- Presence of urinary catheter, OXA48 carbapenemase-producing Enterobacterales (CPE), and Escherichia coli carriage were found to be protective factors against contamination.
- No significant differences in environmental contamination were observed between Escherichia coli and other Enterobacterales, or between ESBL-PE and CPE.
Conclusions:
- Patients with VRE exhibit substantially higher hospital environmental contamination rates compared to those with ESBL-PE and CPE.
- Environmental dissemination rates for ESBL-PE and CPE were low in this study.
- Larger-scale studies are recommended to validate these findings and inform infection control strategies.
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