Multi-country cross-sectional study of colonization with multidrug-resistant organisms: protocol and methods for the Antibiotic Resistance in Communities and Hospitals (ARCH) studies.
Antimicrobial resistance
Global health security
MDRO
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
16 07 2021
16 07 2021
Historique:
received:
16
11
2020
accepted:
06
07
2021
entrez:
17
7
2021
pubmed:
18
7
2021
medline:
6
8
2021
Statut:
epublish
Résumé
Antimicrobial resistance is a global health emergency. Persons colonized with multidrug-resistant organisms (MDROs) are at risk for developing subsequent multidrug-resistant infections, as colonization represents an important precursor to invasive infection. Despite reports documenting the worldwide dissemination of MDROs, fundamental questions remain regarding the burden of resistance, metrics to measure prevalence, and determinants of spread. We describe a multi-site colonization survey protocol that aims to quantify the population-based prevalence and associated risk factors for colonization with high-threat MDROs among community dwelling participants and patients admitted to hospitals within a defined population-catchment area. Researchers in five countries (Bangladesh, Chile, Guatemala, Kenya, and India) will conduct a cross-sectional, population-based prevalence survey consisting of a risk factor questionnaire and collection of specimens to evaluate colonization with three high-threat MDROs: extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Healthy adults residing in a household within the sampling area will be enrolled in addition to eligible hospitalized adults. Colonizing isolates of these MDROs will be compared by multilocus sequence typing (MLST) to routinely collected invasive clinical isolates, where available, to determine potential pathogenicity. A colonizing MDRO isolate will be categorized as potentially pathogenic if the MLST pattern of the colonizing isolate matches the MLST pattern of an invasive clinical isolate. The outcomes of this study will be estimates of the population-based prevalence of colonization with ESCrE, CRE, and MRSA; determination of the proportion of colonizing ESCrE, CRE, and MRSA with pathogenic characteristics based on MLST; identification of factors independently associated with ESCrE, CRE, and MRSA colonization; and creation an archive of ESCrE, CRE, and MRSA isolates for future study. This is the first study to use a common protocol to evaluate population-based prevalence and risk factors associated with MDRO colonization among community-dwelling and hospitalized adults in multiple countries with diverse epidemiological conditions, including low- and middle-income settings. The results will be used to better describe the global epidemiology of MDROs and guide the development of mitigation strategies in both community and healthcare settings. These standardized baseline surveys can also inform future studies seeking to further characterize MDRO epidemiology globally.
Sections du résumé
BACKGROUND
Antimicrobial resistance is a global health emergency. Persons colonized with multidrug-resistant organisms (MDROs) are at risk for developing subsequent multidrug-resistant infections, as colonization represents an important precursor to invasive infection. Despite reports documenting the worldwide dissemination of MDROs, fundamental questions remain regarding the burden of resistance, metrics to measure prevalence, and determinants of spread. We describe a multi-site colonization survey protocol that aims to quantify the population-based prevalence and associated risk factors for colonization with high-threat MDROs among community dwelling participants and patients admitted to hospitals within a defined population-catchment area.
METHODS
Researchers in five countries (Bangladesh, Chile, Guatemala, Kenya, and India) will conduct a cross-sectional, population-based prevalence survey consisting of a risk factor questionnaire and collection of specimens to evaluate colonization with three high-threat MDROs: extended-spectrum cephalosporin-resistant Enterobacteriaceae (ESCrE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA). Healthy adults residing in a household within the sampling area will be enrolled in addition to eligible hospitalized adults. Colonizing isolates of these MDROs will be compared by multilocus sequence typing (MLST) to routinely collected invasive clinical isolates, where available, to determine potential pathogenicity. A colonizing MDRO isolate will be categorized as potentially pathogenic if the MLST pattern of the colonizing isolate matches the MLST pattern of an invasive clinical isolate. The outcomes of this study will be estimates of the population-based prevalence of colonization with ESCrE, CRE, and MRSA; determination of the proportion of colonizing ESCrE, CRE, and MRSA with pathogenic characteristics based on MLST; identification of factors independently associated with ESCrE, CRE, and MRSA colonization; and creation an archive of ESCrE, CRE, and MRSA isolates for future study.
DISCUSSION
This is the first study to use a common protocol to evaluate population-based prevalence and risk factors associated with MDRO colonization among community-dwelling and hospitalized adults in multiple countries with diverse epidemiological conditions, including low- and middle-income settings. The results will be used to better describe the global epidemiology of MDROs and guide the development of mitigation strategies in both community and healthcare settings. These standardized baseline surveys can also inform future studies seeking to further characterize MDRO epidemiology globally.
Identifiants
pubmed: 34271883
doi: 10.1186/s12889-021-11451-y
pii: 10.1186/s12889-021-11451-y
pmc: PMC8285890
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
1412Subventions
Organisme : CDC HHS
ID : GH001297
Pays : United States
Organisme : CDC HHS
ID : GH002143
Pays : United States
Organisme : ACL HHS
ID : U01GH002241
Pays : United States
Organisme : CDC HHS
ID : #75D301-18C-02925
Pays : United States
Organisme : CDC HHS
ID : GH001859
Pays : United States
Organisme : CGH CDC HHS
ID : U01 GH002241
Pays : United States
Informations de copyright
© 2021. The Author(s).
Références
Am J Respir Crit Care Med. 2008 Feb 1;177(3):348-55
pubmed: 17989346
Antimicrob Agents Chemother. 2010 Sep;54(9):3564-8
pubmed: 20547788
N Engl J Med. 2006 Aug 17;355(7):666-74
pubmed: 16914702
Lancet Infect Dis. 2008 Mar;8(3):159-66
pubmed: 18291338
Lancet Infect Dis. 2018 Mar;18(3):241-242
pubmed: 29396007
Lancet Infect Dis. 2017 Jan;17(1):78-85
pubmed: 27751772
Am J Infect Control. 2016 May 1;44(5):539-43
pubmed: 26899297
Clin Infect Dis. 2003 Jan 1;36(1):53-9
pubmed: 12491202
Sex Transm Infect. 2006 Jun;82 Suppl 3:iii64-70
pubmed: 16735296
Clin Infect Dis. 2012 Oct;55(7):967-75
pubmed: 22718774
Int J Infect Dis. 2017 Nov;64:58-66
pubmed: 28890179
Ulster Med J. 2007 May;76(2):68-71
pubmed: 17476819
Clin Infect Dis. 2016 Aug 1;63(3):310-8
pubmed: 27143671
Wellcome Open Res. 2019 Oct 23;4:160
pubmed: 31976380
J Clin Microbiol. 2010 Jan;48(1):202-7
pubmed: 19923490
J Clin Microbiol. 2009 Sep;47(9):2975-80
pubmed: 19571020
J Antimicrob Chemother. 2005 Jul;56(1):52-9
pubmed: 15917288
AIDS. 1998 Jul 9;12(10):1227-34
pubmed: 9677172
Annu Rev Public Health. 2007;28:435-47
pubmed: 17094768
Emerg Infect Dis. 2010 May;16(5):797-803
pubmed: 20409369
Clin Epidemiol. 2018 Oct 12;10:1489-1501
pubmed: 30349396
Clin Infect Dis. 2004 Sep 15;39(6):776-82
pubmed: 15472807
J Infect Dis. 2008 May 1;197(9):1226-34
pubmed: 18422434
Clin Microbiol Infect. 2016 May;22(5):416-22
pubmed: 26706614
J Hosp Infect. 2016 Sep;94(1):54-9
pubmed: 27392978
Ann Intern Med. 2006 Mar 7;144(5):318-25
pubmed: 16520472
J Antimicrob Chemother. 2013 Sep;68(9):2144-53
pubmed: 23674762
J Antimicrob Chemother. 2007 Nov;60(5):913-20
pubmed: 17848376
Surg Infect (Larchmt). 2008 Aug;9(4):469-74
pubmed: 18399783
Infect Control Hosp Epidemiol. 2009 Oct;30(10):972-6
pubmed: 19712030
Int J Med Microbiol. 2015 Jan;305(1):148-56
pubmed: 25547265
Clin Infect Dis. 2002 Feb 15;34(4):425-33
pubmed: 11797167
Int J Antimicrob Agents. 2017 Aug;50(2):127-134
pubmed: 28647532
Commun Dis Intell Q Rep. 2009 Mar;33(1):10-20
pubmed: 19618763