Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards.
Adult
Aged
Bacteremia
/ prevention & control
Cross Infection
/ microbiology
Drug Resistance, Multiple, Bacterial
Escherichia coli
/ isolation & purification
Escherichia coli Infections
/ prevention & control
Female
Gloves, Protective
Hematology
Hospital Units
/ statistics & numerical data
Humans
Infection Control
/ methods
Male
Middle Aged
Oncology Service, Hospital
Prospective Studies
Universal Precautions
Contact precautions
Infection control
Molecular epidemiology
Multidrug-resistant Gram-negative bacteria
Nosocomial transmission
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Aug 2019
Aug 2019
Historique:
received:
20
08
2018
revised:
15
12
2018
accepted:
23
12
2018
pubmed:
15
1
2019
medline:
22
11
2019
entrez:
15
1
2019
Statut:
ppublish
Résumé
Colonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited. We performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis. Within 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729. Use of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting.
Identifiants
pubmed: 30641228
pii: S1198-743X(18)30840-1
doi: 10.1016/j.cmi.2018.12.029
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1013-1020Informations de copyright
Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.