Modelling interventions and contact networks to reduce the spread of carbapenem-resistant organisms between individuals in the ICU.
Antibacterial drug resistance
Carbapenems
Healthcare worker–patient
Operations research
Transmission
Universal precautions
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Jun 2023
Jun 2023
Historique:
received:
22
08
2022
revised:
25
01
2023
accepted:
03
02
2023
pmc-release:
01
06
2024
medline:
5
6
2023
pubmed:
13
3
2023
entrez:
12
3
2023
Statut:
ppublish
Résumé
Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited. To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization. CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI). The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions. The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition). Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29). In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
Sections du résumé
BACKGROUND
BACKGROUND
Contact precautions are widely used to prevent the transmission of carbapenem-resistant organisms (CROs) in hospital wards. However, evidence for their effectiveness in natural hospital environments is limited.
OBJECTIVE
OBJECTIVE
To determine which contact precautions, healthcare worker (HCW)-patient interactions, and patient and ward characteristics are associated with greater risk of CRO infection or colonization.
DESIGN, SETTING AND PARTICIPANTS
METHODS
CRO clinical and surveillance cultures from two high-acuity wards were assessed through probabilistic modelling to characterize a susceptible patient's risk of CRO infection or colonization during a ward stay. User- and time-stamped electronic health records were used to build HCW-mediated contact networks between patients. Probabilistic models were adjusted for patient (e.g. antibiotic administration) and ward (e.g. hand hygiene compliance, environmental cleaning) characteristics. The effects of risk factors were assessed by adjusted odds ratio (aOR) and 95% Bayesian credible intervals (CrI).
EXPOSURES
METHODS
The degree of interaction with CRO-positive patients, stratified by whether CRO-positive patients were on contact precautions.
MAIN OUTCOMES AND MEASURES
METHODS
The prevalence of CROs and number of new carriers (i.e. incident CRO aquisition).
RESULTS
RESULTS
Among 2193 ward visits, 126 (5.8%) patients became colonized or infected with CROs. Susceptible patients had 4.8 daily interactions with CRO-positive individuals on contact precautions (vs 1.9 interactions with those not on contact precautions). The use of contact precautions for CRO-positive patients was associated with a reduced rate (7.4 vs 93.5 per 1000 patient-days at risk) and odds (aOR 0.03, 95% CrI 0.01-0.17) of CRO acquisition among susceptible patients, resulting in an estimated absolute risk reduction of 9.0% (95% CrI 7.6-9.2%). Also, carbapenem administration to susceptible patients was associated with increased odds of CRO acquisition (aOR 2.38, 95% CrI 1.70-3.29).
CONCLUSIONS AND RELEVANCE
CONCLUSIONS
In this population-based cohort study, the use of contact precautions for patients colonized or infected with CROs was associated with lower risk of CRO acquisition among susceptible patients, even after adjusting for antibiotic exposure. Further studies that include organism genotyping are needed to confirm these findings.
Identifiants
pubmed: 36907332
pii: S0195-6701(23)00073-7
doi: 10.1016/j.jhin.2023.02.016
pmc: PMC10315994
mid: NIHMS1882694
pii:
doi:
Substances chimiques
Carbapenems
0
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1-7Subventions
Organisme : NIAID NIH HHS
ID : K24 AI141580
Pays : United States
Organisme : ACL HHS
ID : U01CK000536
Pays : United States
Organisme : NCEZID CDC HHS
ID : U54 CK000447
Pays : United States
Organisme : ACL HHS
ID : U54CK000447
Pays : United States
Informations de copyright
Copyright © 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
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