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Clin Microbiol Infect. 2019 Jan 12. pii: S1198-743X(18)30840-1. doi: 10.1016/j.cmi.2018.12.029. [Epub ahead of print]

Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards.

Author information

1
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research, Partner site Bonn-Cologne, Germany.
2
German Centre for Infection Research, Partner site Bonn-Cologne, Germany; Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany.
3
Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Germany.
4
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.
5
Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany; German Centre for Infection Research, Partner site Tübingen, Germany.
6
Department of Medical Oncology, Haematology, Immunology, Rheumatology and Pulmonology, University Hospital Tübingen, Tübingen, Germany; Clinical Collaboration Unit Translational Immunology, German Cancer Consortium (DKTK) and German Cancer Research Centre (DKFZ), Partner site Tübingen, Tübingen, Germany.
7
Department of Medical Oncology, Haematology, Immunology, Rheumatology and Pulmonology, University Hospital Tübingen, Tübingen, Germany.
8
Division of Infection Control and Infectious Diseases, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany.
9
Department of Haematology, Oncology, Haemostaseology, and Stem Cell Transplantation, Medical Faculty, RWTH Aachen University Hospital, Aachen, Germany.
10
Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany; German Centre for Infection Research, Partner site Hamburg-Lübeck-Borstel, Germany.
11
Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany.
12
Department of Oncology and Haematology, Hubertus Wald Tumorzentrum/University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
13
Institute of Medical Microbiology, Justus-Liebig University, Giessen, Germany; German Centre for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Germany.
14
Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research, Partner site Bonn-Cologne, Germany. Electronic address: Maria.vehreschild@uk-koeln.de.

Abstract

OBJECTIVES:

Colonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited.

METHODS:

We performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis.

RESULTS:

Within 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729.

CONCLUSIONS:

Use of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting.

KEYWORDS:

Contact precautions; Infection control; Molecular epidemiology; Multidrug-resistant Gram-negative bacteria; Nosocomial transmission

PMID:
30641228
DOI:
10.1016/j.cmi.2018.12.029

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