Skip to main content
×
Home

Determinants of Implementation of Isolation Precautions Against Infections by Multidrug-Resistant Microorganisms: A Hospital-Based, Multicenter, Observational Study

  • Thomas Bénet (a1) (a2), Raphaele Girard (a1), Solweig Gerbier-Colomban (a1), Cédric Dananché (a1) (a2), Elisabeth Hodille (a3), Olivier Dauwalder (a3) and Philippe Vanhems (a1) (a2)...
Abstract
OBJECTIVES

We aimed to ascertain the factors associated with lack of isolation precautions (IP) in patients infected or colonized by third-generation cephalosporin-resistant Enterobacteriaceae (3GCR-E) and methicillin-resistant Staphylococcus aureus (MRSA) in hospital settings.

DESIGN

Prospective surveillance and audit of practices.

SETTING

The study included 4 university hospitals in Lyon, France.

PARTICIPANTS

All patients hospitalized between April and June in 2013 and 2015 were included. Case patients had ≥1 clinical sample positive for MRSA and/or 3GCR-E.

METHODS

Factors associated with the lack of IP implementation were identified using multivariate logistic regression. The incidence of MDRO infections was expressed per 10,000 patient days.

RESULTS

Overall, 57,222 patients accounting for 192,234 patient days of hospitalization were included, and 635 (1.1%) MDRO cases were identified. MRSA incidence was 2.5 per 10,000 patient days (95% confidence interval [95% CI], 2.1–3.0) and 3GCR-E incidence was 10.1 per 10,000 patient days (95% CI, 9.2–11.0), with no crude difference between 2013 and 2015 (P=.15 and P=.11, respectively). Among 3GCR-E, the main species were Escherichia coli (43.8%) and Klebsiella pneumoniae (31.0%). Isolation precautions were implemented in 78.5% of cases. Lack of IP implementation was independently associated with patient age, year, specialty, hospital, colonization compared with infection, and lack of medical prescription for IPs (adjusted odds ratio, 17.4; 95% CI, 8.5–35.8; P<.001).

CONCLUSIONS

MRSA and 3GCR-E infections and/or colonizations are frequent in healthcare settings, and IPs are implemented in most cases. When IPs are lacking, the main factor is the absence of medical prescription for IPs, underscoring the need for alerts to physicians by the microbiological laboratory and/or the infection control team.

Infect Control Hosp Epidemiol 2017;38:1188–1195

Copyright
Corresponding author
Address correspondence to Thomas Bénet, MD, PhD, Service d’Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, 5 place d’Arsonval, 69437 Lyon Cedex 03, France (thomas.benet@chu-lyon.fr).
References
Hide All
1. Review on antimicrobial resistance proposes ways to drive development of new drugs. Antibiotic Action website. http://antibiotic-action.com. Updated 2017. Accessed June 23, 2017.
2. de Kraker MEA, Jarlier V, Monen JCM, Heuer OE, van de Sande N, Grundmann H. The changing epidemiology of bacteraemias in Europe: trends from the European Antimicrobial Resistance Surveillance System. Clin Microbiol Infect 2013;19:860868.
3. Boucher HW, Corey GR. Epidemiology of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2008;46(Suppl 5):S344S349.
4. Schwaber MJ, Carmeli Y. Mortality and delay in effective therapy associated with extended-spectrum β-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother 2007;60:913920.
5. Köck R, Becker K, Cookson B, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill 2010;15:19688.
6. Olearo F, Albrich W, Harbarth S, Kronenberg A. Ten years of MRSA surveillance in Switzerland: similarities and differences with Europe. Antimicrob Resist Infect Control 2015;4(Suppl 1):O8.
7. Leistner R, Schröder C, Geffers C, Breier A-C, Gastmeier P, Behnke M. Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS). Clin Microbiol Infect 2015;21:255.e1255.e5.
8. Coque TM, Baquero F, Canton R. Increasing prevalence of ESBL-producing Enterobacteriaceae in Europe. Euro Surveill 2008;13(47):pii=19044.
9. Thaden JT, Fowler VG, Sexton DJ, Anderson DJ. Increasing incidence of extended-spectrum β-lactamase-producing Escherichia coli in community hospitals throughout the southeastern United States. Infect Control Hosp Epidemiol 2016;37:4954.
10. Baker P, Cohen B, Liu J, Larson E. Incidence and risk factors for community-associated methicillin-resistant Staphylococcus aureus in New York City, 2006–2012. Epidemiol nfect 2016;144:10141017.
11. Molton JS, Tambyah PA, Ang BSP, Ling ML, Fisher DA. The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia. Clin Infect Dis 2013;56:13101318.
12. 2007 Isolation precautions: Appendix A - HICPAC. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/2007IP/2007ip_appendA.html. Published 2007. Accessed May 19, 2016.
13. Jernigan JA, Titus MG, Gröschel DHM, Getchell-White SI, Farr BM. Effectiveness of contact isolation during a hospital outbreak of methicillin resistant Staphylococcus aureus . Am J Epidemiol 1996;143:496504.
14. Morgan DJ, Kaye KS, Diekema DJ. Reconsidering isolation precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus . JAMA 2014;312:13951396.
15. Dhar S, Marchaim D, Tansek R, et al. Contact precautions: more is not necessarily better. Infect Control Hosp Epidemiol 2014;35:213221.
16. Reuland EA, Al Naiemi N, Kaiser AM, et al. Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in Amsterdam. J Antimicrob Chemother 2016;71:10761082.
17. Clock SA, Cohen B, Behta M, Ross B, Larson EL. Contact precautions for multidrug-resistant organisms: current recommendations and actual practice. Am J Infect Control 2010;38:105111.
18. Carbonne A, Arnaud I, Maugat S, et al. National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: a 9 year experience. J Antimicrob Chemother 2013;68:954959.
19. Schwaber MJ, Lev B, Israeli A, et al. Containment of a country-wide outbreak of carbapenem-resistant Klebsiella pneumoniae in Israeli hospitals via a nationally implemented intervention. Clin Infect Dis 2011;52:848855.
20. Palmore TN, Henderson DK. Managing Transmission of carbapenem-resistant Enterobacteriaceae in healthcare settings: a view from the trenches. Clin Infect Dis 2013;57:15931599.
21. Tacconelli E, Cataldo MA, Dancer SJ, et al. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014;20(Suppl 1):S1S55.
22. Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med 2005;165:424429.
23. Lisby M, Nielsen LP, Mainz J. Errors in the medication process: frequency, type, and potential clinical consequences. Int J Qual Health Care 2005;17:1522.
24. Kopp BJ, Erstad BL, Allen ME, Theodorou AA, Priestley G. Medication errors and adverse drug events in an intensive care unit: direct observation approach for detection. Crit Care Med 2006;34:415425.
25. Bergstrom N, Braden B, Kemp M, Champagne M, Ruby E. Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses, and prescription of preventive Interventions. J Am Geriatr Soc 1996;44:2230.
26. Ikram R, Psutka R, Carter A, Priest P. An outbreak of multi-drug resistant Escherichia coli urinary tract infection in an elderly population: a case-control study of risk factors. BMC Infect Dis 2015;15:224.
27. Wybo I, Blommaert L, De Beer T, et al. Outbreak of multidrug-resistant Acinetobacter baumannii in a Belgian university hospital after transfer of patients from Greece. J Hosp Infect 2007;67:374380.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 5
Total number of PDF views: 124 *
Loading metrics...

Abstract views

Total abstract views: 1073 *
Loading metrics...

* Views captured on Cambridge Core between 31st July 2017 - 20th November 2017. This data will be updated every 24 hours.