TY - JOUR
T1 - No nosocomial transmission under standard hygiene precautions in short term contact patients in case of an unexpected ESBL or Q&A E. coli positive patient
T2 - A one-year prospective cohort study within three regional hospitals
AU - Souverein, Dennis
AU - Euser, Sjoerd M.
AU - Herpers, Bjorn L.
AU - Hattink, Corry
AU - Houtman, Patricia
AU - Popma, Amerens
AU - Kluytmans, Jan
AU - Rossen, John W.A.
AU - Den Boer, Jeroen W.
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/6/26
Y1 - 2017/6/26
N2 - Background: Many Highly Resistant Gram Negative Rod (HR-GNR) positive patients are found unexpectedly in clinical cultures, besides patients who are screened and isolated based on risk factors. As unexpected HR-GNR positive patients are isolated after detection, transmission to contact patients possibly occurred. The added value of routine contact tracing in such situations within hospitals with standard hygiene precautions is unknown. Methods: In 2014, this study was performed as a prospective cohort study. Index patients were defined as those tested unexpectedly HR-GNR positive in clinical cultures to diagnose a possible infection and were nursed under standard hygiene precautions before tested positive. After detection they were nursed in contact isolation. Contact patients were still hospitalized and shared the same room with the index patient for at least 12h. HR-GNR screening was performed by culturing a rectal and throat swab. Clonal relatedness of HR-GNR isolates was determined using whole genome sequencing (WGS). Results: Out of 152 unexpected HR-GNR positive patients, 35 patients (23.0%) met our inclusion criteria for index patient. ESBL E. coli was found most frequently (n=20, 57.1%), followed by Q&A E. coli (n=10, 28.6%), ESBL K. pneumoniae (n=3, 8.5%), ESBL R. ornithinolytica (n=1, 2.9%) and multi resistant P. aeruginosa (n=1, 2.9%). After contact tracing, 69 patients were identified as contact patient of an index patient, with a median time between start of contact and sampling of 3 days. None were found HR-GNR positive by nosocomial transmission. Conclusions: In a local setting within hospitals with standard hygiene precautions, routine contact tracing among unexpected HR-GNR positive patients may be replaced by appropriate surveillance as we found no nosocomial transmission in short term contacts.
AB - Background: Many Highly Resistant Gram Negative Rod (HR-GNR) positive patients are found unexpectedly in clinical cultures, besides patients who are screened and isolated based on risk factors. As unexpected HR-GNR positive patients are isolated after detection, transmission to contact patients possibly occurred. The added value of routine contact tracing in such situations within hospitals with standard hygiene precautions is unknown. Methods: In 2014, this study was performed as a prospective cohort study. Index patients were defined as those tested unexpectedly HR-GNR positive in clinical cultures to diagnose a possible infection and were nursed under standard hygiene precautions before tested positive. After detection they were nursed in contact isolation. Contact patients were still hospitalized and shared the same room with the index patient for at least 12h. HR-GNR screening was performed by culturing a rectal and throat swab. Clonal relatedness of HR-GNR isolates was determined using whole genome sequencing (WGS). Results: Out of 152 unexpected HR-GNR positive patients, 35 patients (23.0%) met our inclusion criteria for index patient. ESBL E. coli was found most frequently (n=20, 57.1%), followed by Q&A E. coli (n=10, 28.6%), ESBL K. pneumoniae (n=3, 8.5%), ESBL R. ornithinolytica (n=1, 2.9%) and multi resistant P. aeruginosa (n=1, 2.9%). After contact tracing, 69 patients were identified as contact patient of an index patient, with a median time between start of contact and sampling of 3 days. None were found HR-GNR positive by nosocomial transmission. Conclusions: In a local setting within hospitals with standard hygiene precautions, routine contact tracing among unexpected HR-GNR positive patients may be replaced by appropriate surveillance as we found no nosocomial transmission in short term contacts.
KW - Contact isolation
KW - Contact tracing
KW - ESBL
KW - HR-GNRs
KW - Transmission
UR - http://www.scopus.com/inward/record.url?scp=85021239743&partnerID=8YFLogxK
U2 - 10.1186/s13756-017-0228-6
DO - 10.1186/s13756-017-0228-6
M3 - Article
C2 - 28670449
AN - SCOPUS:85021239743
SN - 2047-2994
VL - 6
JO - Antimicrobial Resistance and Infection Control
JF - Antimicrobial Resistance and Infection Control
IS - 1
M1 - 69
ER -