Abstract
BackgroundMany 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.MethodsIn 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 12 h. 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).ResultsOut 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.ConclusionsIn 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.
Highlights
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
Studies report on the prevalence of HR-GNRs, including Extended Spectrum Beta-Lactamase (ESBL) (Extended Spectrum Beta Lactamase) producing bacteria isolated from hospitalized patients, general practitioner patients and nursing home residents [5,6,7,8,9]
HR-GNRs considered in the present study were (1) Enterobacteriaceae that were Extended Spectrum Beta-Lactamase (ESBL) and/or carbapenemase positive (CPE) and/or resistant to Fluoroquinolones and Aminoglycosides (Q&A), (2) Acinetobacter species that were carbapenemase positive and/or resistant to Resistant to Fluoroquinolones and Aminoglycosides (Q&A), (3) Stenotrophomonas maltophilia resistant to co-trimoxazole and (4) multi-resistant Pseudomonas aeruginosa, defined as resistant to at least three of the following antibiotics or antibiotic groups: piperacillin, ceftazidime, fluoroquinolones, aminoglycosides and/or carbapenemase positive
Summary
Study design and setting The present study was performed as a prospective cohort study. Screening of contact patients was performed by sampling a rectal and throat swab (Copan eSwab including 1 mL of modified liquid Amies) supplemented with wound samples when present as soon as possible after detection of the index patient. For all HR-GNR positive patients, isolation measures were maintained during the total admission time and study period. When the index patient was positive for a HR-GNR (including ESBLs) rectal and throat swabs from contact patient(s) were analysed by direct culturing on both an ESBL screening agar (ChromID ESBL-ID, bioMerieux, enriched with a mixture of antibiotics, including cefpodoxime) and a CLED GM20 agar (cystine lactose electrolyte deficient agar with 20 mg/L gentamicin, Oxoid). The overall cumulative HR-GNR incidence and incidence density for the study period was calculated by dividing the number of HR-GNR positive hospitalized patients by the total number of admissions and (hospital) patient-days. All statistical analyses were performed using IBM SPSS Statistics version 24.0
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
