Risk factors for transmission of carbapenem-resistant Enterobacterales to healthcare personnel gloves and gowns in the USA

O’Hara, Lyndsay M.; Calfee, David P.; Miller, Loren G.; Pineles, Lisa; Magder, Larry; Johnson, J. Kristie; Morgan, Daniel J; Rasko, David A.; Harris, Anthony D.; Program, Cdc Prevention Epicenters

doi:10.1016/j.jhin.2020.12.012

Cited by 12 publications

(18 citation statements)

References 21 publications

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“…Given that multiantibioticresistant bacteria survive for long periods in hospital environments and the low immunity of inpatients, inadequate or inappropriate prevention and control measures by a hospital may lead to a high tendency of cross-infection or even an outbreak among healthcare workers and patients. O'Hara et al reported that the gloves and gowns of healthcare workers were prone to contamination by carbapenemresistant Enterobacterales members and are considered to play an important role in the transmission of antibiotic-resistant bacteria among inpatients (O'Hara et al, 2021). This finding suggests that improvements in hand hygiene and environmental disinfection for reducing the occurrence of hospital-acquired infection have effectively prevented CR-GNB infection.…”

Section: Discussionmentioning

confidence: 99%

“…O’Hara et al. reported that the gloves and gowns of healthcare workers were prone to contamination by carbapenem-resistant Enterobacterales members and are considered to play an important role in the transmission of antibiotic-resistant bacteria among inpatients ( O'Hara et al., 2021 ). This finding suggests that improvements in hand hygiene and environmental disinfection for reducing the occurrence of hospital-acquired infection have effectively prevented CR-GNB infection.…”

Section: Discussionmentioning

confidence: 99%

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Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development

Liao

Zhi

et al. 2023

Front. Cell. Infect. Microbiol.

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In this study, we analyzed the antibiotic resistance of carbapenem-resistant gram-negative bacteria (CR-GNB) in intensive care unit (ICU) patients and developed a predictive model. We retrospectively collected the data of patients with GNB infection admitted to the ICU of the First Affiliated Hospital of Fujian Medical University, who were then divided into a CR and a carbapenem-susceptible (CS) group for CR-GNB infection analysis. Patients admitted between December 1, 2017, and July 31, 2019, were assigned to the experimental cohort (n = 205), and their data were subjected to multivariate logistic regression analysis to identify independent risk factors for constructing the nomogram-based predictive model. Patients admitted between August 1, 2019, and September 1, 2020, were assigned to the validation cohort for validating the predictive model (n = 104). The Hosmer−Lemeshow test and receiver operating characteristic (ROC) curve analysis were used to validate the model’s performance. Overall, 309 patients with GNB infection were recruited. Of them, 97 and 212 were infected with CS-GNB and CR-GNB, respectively. Carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa (CRPA) were the most prevalent CR-GNB. The multivariate logistic regression analysis results of the experimental cohort revealed that a history of combination antibiotic treatments (OR: 3.197, 95% CI: 1.561–6.549), hospital-acquired infection (OR: 3.563, 95% CI: 1.062–11.959) and mechanical ventilation ≥ 7 days (OR: 5.096, 95% CI: 1.865–13.923) were independent risk factors for CR-GNB infection, which were then used for nomogram construction. The model demonstrated a good fit of observed data (p = 0.999), with an area under the ROC curve (AUC) of 0.753 (95% CI: 0.685–0.820) and 0.718 (95% CI: 0.619–0.816) for the experimental and validation cohort, respectively. The decision curve analysis results suggested that the model has a high practical value for clinical practice. The Hosmer−Lemeshow test indicated a good fit of the model in the validation cohort (p-value, 0.278). Overall, our proposed predictive model exhibited a good predictive value in identifying patients at high risk of developing CR-GNB infection in the ICU and could be used to guide preventive and treatment measures.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development

Liao

Zhi

et al. 2023

Front. Cell. Infect. Microbiol.

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show abstract

Section: Discussionmentioning

confidence: 99%

Rising incidence of carbapenem resistant isolates: an Argentinian hospital’s experience. More trouble in the aftermath of the COVID-19 pandemic

Castro¹,

Ubiergo²,

Vicino³

et al. 2022

Iberoam J Med

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Introduction: During COVID-19 outbreaks, disproportionate use of antibiotics, high Intensive Care Units burden and longer in-hospital stays may have aggravated the emergency posed by carbapenem-resistant isolates. Therefore, we set out to determine whether the incidence of carbapenem-resistant isolates rose in a tertiary care center in Santa Fe, Argentina during the period with active cases of COVID-19. Material and methods: In this retrospectively designed analytic epidemiologic study, two periods were defined: Period 1 (without active cases of COVID-19) from September 2019 to August 2020 and Period 2 (starting at the onset of the first wave of COVID-19 in this Institution) from September 2020 to June 2021. All clinically relevant microbiological samples taken during these periods in the Internal Medicine, Surgical and Intensive Care Unit wards were included. The primary analysis of interest was the differential incidence between the two periods, overall and in the Intensive Care Units wards in particular. Results: 9,135 hospitalizations, 50,145 patient-days of analysis. 7,285 clinical samples were taken, with an overall positivity for carbapenem-resistant isolates of 12.1% (n=883). Overall carbapenem-resistant isolates incidence during Period 2 was 2.5 times higher than in Period 1 (2.52 vs 0.955/100 patient-days, p<0.001). Intensive Care Units’ carbapenem-resistant isolates incidence raised from 6.78 to 8.69/100 patient-days in Period 2 (p=0.006). Conclusions: We found alarming rates of carbapenem-resistant isolates in our center, 2.5 times higher in the period following the first wave of COVID-19. This rise was due to a higher amount of clinically relevant microbiological samples taken and to a higher carbapenem resistance among Enterobacteria and non-fermentative Gram-negative bacilli. To our knowledge, this is one of the few Latin-American reports on the effect of the COVID-19 pandemic on carbapenem-resistant isolates incidence.

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“…Moreover, the use of personal protective equipment created a false sense of security for the personnel tending to cohorted COVID-19 patients. This false sense of security is a particularly dangerous epidemiological threat, since it has already been shown that there is a high likelihood of carriage of carbapenem-resistant Enterobacterales in gowns and gloves that come in contact with carriers of CRI (37). On top of that, some have reported, in the context of scarce resources, to have stopped routine rectal screening during the COVID-19 pandemic (38), therefore not being able to identify the patients that pose the highest risk, Even more, during the COVID-19 pandemic, contact and respiratory isolation for all patients posed a significant burden on the health personnel.…”

Section: Discussionmentioning

confidence: 99%

An outbreak inside an outbreak: rising incidence of carbapenem-resistant isolates during the COVID-19 pandemic. Report from a tertiary care center in Argentina

Castro¹,

Ubiergo²,

Vicino³

et al. 2021

Preprint

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IntroductionCOVID-19 outbreaks have left us to deal with an aftermath on many fronts. In particular, disproportionate use of antibiotics, high ICU burden and longer in-hospital stays during the pandemic have been proposed to aggravate the emergency posed by carbapenem-resistant isolates (CRI), specially through carbapenemase production. However, there have been few reports worldwide regarding changes in CRI incidence and little latinamerican literature.ObjectiveWe set out to determine whether the incidence of CRI rose in a tertiary care center in Santa Fe, Argentina during the time period with active cases of COVID-19.MethodsAnalytic epidemiologic study retrospectively designed. Two time periods were defined: P1 (without active cases of COVID-19) from September, 2019 to August, 2020 and P2 (starting at the onset of the first wave of COVID-19 in this institution) from September, 2020 to June 2021. All clinically-relevant microbiological samples -those meant for diagnostic purposes-taken during the study period from patients in the Internal Medicine and Surgical wards as well as the Intensive Care Units were included. Incidence was calculated by dividing the number of CRI during each time frame by the count of patient-day during that same period, multiplied by a hundred.Results9,135 hospitalizations, 50,145 patient-days of analysis. A total of 7285 clinical samples were taken, with an overall positivity for CRI of 12.1% (n=883). Overall CRI incidence during P2 was 2.5 times higher than in P1 (2.52 vs 0.955/100 patient-days, p <0.001). ICU CRI incidence raised from 6.78 to 8.69/100 patient-days in P2 (p=0.006).ConclusionWe found alarming rates of CRI in our center, 2.5 times higher than previous to the first COVID-19 wave, similar to other reports worldwide. To our knowledge, this is one of the few Latin-American reports on the effect of the COVID-19 pandemic on CRI incidence.

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Risk factors for transmission of carbapenem-resistant Enterobacterales to healthcare personnel gloves and gowns in the USA

Cited by 12 publications

References 21 publications

Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development

Carbapenem-resistant gram-negative bacterial infection in intensive care unit patients: Antibiotic resistance analysis and predictive model development

Rising incidence of carbapenem resistant isolates: an Argentinian hospital’s experience. More trouble in the aftermath of the COVID-19 pandemic

An outbreak inside an outbreak: rising incidence of carbapenem-resistant isolates during the COVID-19 pandemic. Report from a tertiary care center in Argentina

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