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Risk factors for the environmental spread of different multidrug-resistant organisms: a prospective cohort study

  • R. Saliba
    Affiliations
    IAME, UMR 1137, Université Sorbonne Paris Nord, France

    Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France

    Laboratoire des Agents Pathogènes, Saint-Joseph University of Beirut, Beirut, Lebanon
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  • T. Ghelfenstein-Ferreira
    Affiliations
    Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
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  • A. Lomont
    Affiliations
    Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
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  • B. Pilmis
    Affiliations
    Équipe Mobile d'infectiologie, Hôpital Necker Enfants-Malades, Paris, France
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  • E. Carbonnelle
    Affiliations
    IAME, UMR 1137, Université Sorbonne Paris Nord, France

    Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
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  • D. Seytre
    Affiliations
    Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
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  • E. Nasser-Ayoub
    Affiliations
    Service d’Anesthésie et de Réanimation, Hôtel Dieu de France de Beyrouth, Beirut, Lebanon

    Faculty of Medicine, Saint-Joseph University of Beirut, Beirut, Lebanon
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  • J.-R. Zahar
    Correspondence
    Corresponding author. Address: 125 rue de Stalingrad, 93000, Bobigny, France. Tel.: +33 6 03 07 90 88.
    Affiliations
    IAME, UMR 1137, Université Sorbonne Paris Nord, France

    Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France
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  • D. Karam-Sarkis
    Affiliations
    Laboratoire des Agents Pathogènes, Saint-Joseph University of Beirut, Beirut, Lebanon
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Published:February 10, 2021DOI:https://doi.org/10.1016/j.jhin.2021.01.029

      Summary

      Background

      Substantial scientific evidence shows that contamination of environmental surfaces in hospitals plays an important role in the transmission of multidrug-resistant organisms (MDROs). To date, studies have failed to identify the risk factors associated with environmental contamination.

      Aim

      To evaluate, compare, and identify factors associated with environmental contamination around carriers of different MDROs.

      Methods

      This was a prospective cohort study from May 2018 to February 2020. A total of 125 patients were included, having been admitted to Avicenne Hospital and Hotel Dieu de France de Beyrouth Hospital who were faecal carriers of MDROs (extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE)). For each patient, quantification of MDRO in stool was undertaken, plus a qualitative evaluation of the presence of MDRO in six different environmental sites; and clinical data were collected.

      Findings

      MDROs comprised ESBL-PE (34%), CPE (45%), and VRE (21%). The most frequent MDRO species was Escherichia coli. Contamination of at least one environmental site was observed for 22 (18%) patients. Only carriage of VanA was associated with a significantly higher risk of dissemination. Having a urinary catheter, carriage of OXA48 and E. coli were protective factors against environmental contamination. There were no significant differences in environmental contamination between E. coli and other Enterobacterales or between ESBL-PE and CPE.

      Conclusions

      Hospital environmental contamination rates are substantially higher for patients with VRE, compared to the low environment dissemination rates around ESBL-PE and CPE. Further studies on a larger scale are needed to confirm the validity of our findings.

      Keywords

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