Factors associated with Vancomycin-resistant Enterococcus acquisition during a large outbreak

Summary: Between 2013 and 2014 a Vancomycin-resistant Enterococci (VRE) outbreak occurred in a teaching hospital in France. The outbreak was significant possibly due to the lack of implementation of recommended control measures. The aim of this study was to identify the effect of the lack of adherence to control measures for prevention of VRE acquisition in contact patients taking into account individual risk factors.Contact patients (first two months of the outbreak) with VRE acquisition were compared to patients without VRE acquisition (univariate and logistic regression), in terms of institutional characteristics (unit of hospitalization and isolation measures) and risk factors.Between December 2013 and February 2014, 282 contact patients were included in the study. The prevalence of VRE acquisition was 6.4% (18/282). Significant risk factors for VRE acquisition according to logistic regression analysis were; lack of isolation, hospitalization in the same hospital unit as a VRE carrier patient and lack of isolation (RR = 856.8, p = 0.001), hospitalization in a specific unit (RR = 927.4, p = 0.002), McCabe score equal to 2 (RR = 5233.6, p = 0.008), age (RR = 1.2 by year, p = 0.011), hemodialysis (RR = 36.1, p = 0.011), central venous catheter (RR = 25.4, p = 0.021) and surgery (RR = 0.012, p = 0.007). Antibiotic use was a significant risk factor for VRE acquisition using univariate analysis (p < 10−3).The findings confirm that the factors focused on by the study (lack of isolation and dedicated unit) had a significant effect on VRE acquisition as patient associated factors. It highlights the importance of observance of the guidelines. Keywords: Vancomycin-resistant Enterococcus, Outbreak, Colonization, Emerging pathoge

Bacterial Cross-Transmission between Inanimate Surfaces and Patients in Intensive Care Units under Real-World Conditions: A Repeated Cross-Sectional Study

Background/Objectives: Contaminated surfaces play an important role in the nosocomial infection of patients in intensive care units (ICUs). This study, conducted in two ICUs at Edouard Herriot Hospital (Lyon, France), aimed to describe rooms&rsquo; microbial ecology and explore the potential link between environmental contamination and patients&rsquo; colonization and/or infection. Methods: Environmental samples were realized once monthly from January 2020 to December 2021 on surfaces close to the patient (bedrails, bedside table, and dedicated stethoscope) and healthcare workers&rsquo; high-touch surfaces, which were distant from the patient (computer, worktop/nurse cart, washbasin, and hydro-alcoholic solution/soap dispenser). Environmental bacteria were compared to the cultures of the patients hospitalized in the sampled room over a period of &plusmn; 10 days from the environmental sampling. Results: Overall, 137 samples were collected: 90.7% of the samples close to patients, and 87.9% of the distant ones were positives. Overall, 223 bacteria were isolated, mainly: Enterococcus faecalis (15.7%), Pantoea agglomerans (8.1%), Enterobacter cloacae/asburiae (6.3%), Bacillus cereus and other Bacillus spp (6.3%), Enterococcusfaecium (5.8%), Stenotrophomonas maltophilia (5.4%), and Acinetobacter baumannii (4.9%). Throughout the study, 142 patients were included, of which, n = 67 (47.2%) were infected or colonized by at least one bacterium. In fourteen cases, the same bacterial species were found both in environment and patient samples, with the suspicion of a cross-contamination between the patient&ndash;environment (n = 10) and environment&ndash;patient (n = 4). Conclusions: In this work, we found a high level of bacterial contamination on ICU rooms&rsquo; surfaces and described several cases of potential cross-contamination between environment and patients in real-world conditions

Strain-specific estimation of epidemic success provides insights into the transmission dynamics of tuberculosis

International audienceThe transmission dynamics of tuberculosis involves complex interactions of socio-economic and, possibly, microbiological factors. We describe an analytical framework to infer factors of epidemic success based on the joint analysis of epidemiological, clinical and pathogen genetic data. We derive isolate-specific, genetic distance-based estimates of epidemic success, and we represent success-related time-dependent concepts, namely epidemicity and endemicity, by restricting analysis to specific time scales. The method is applied to analyze a surveillance-based cohort of 1,641 tuberculosis patients with minisatellite-based isolate genotypes. Known predictors of isolate endemicity (older age, native status) and epidemicity (younger age, sputum smear positivity) were identified with high confidence (P \textless 0.001). Long-term epidemic success also correlated with the ability of Euro-American and Beijing MTBC lineages to cause active pulmonary infection, independent of patient age and country of origin. Our results demonstrate how important insights into the transmission dynamics of tuberculosis can be gained from active surveillance data

Changing patterns of human migrations shaped the global population structure of Mycobacterium tuberculosis in France

Abstract Mycobacterium tuberculosis (Mtb) exhibits a structured phylogeographic distribution worldwide linked with human migrations. We sought to infer how the interactions between distinct human populations shape the global population structure of Mtb on a regional scale. We applied the recently described timescaled haplotypic density (THD) technique on 638 minisatellite-based Mtb genotypes from French tuberculosis patients. THD with a long-term (200 y) timescale indicated that Mtb population in France had been mostly influenced by interactions with Eastern and Southern Europe and, to a lesser extent, Northern and Middle Africa, consistent with historical migrations favored by geographic proximity or commercial exchanges with former French colonies. Restricting the timescale to 20 y, THD identified a sustained influence of Northern Africa, but not Europe where tuberculosis incidence decreased sharply. Evolving interactions between human populations, thus, measurably influence the local population structure of Mtb. Relevant information on such interactions can be inferred using THD from Mtb genotypes

Prospective Whole-Genome Sequencing in Tuberculosis Outbreak Investigation, France, 2017–2018

During June 2017–April 2018, active tuberculosis with Beijing SIT1 isolates was diagnosed in 14 persons living in 4 distant cities in France. Whole-genome sequencing indicated that these patients belonged to a single transmission chain. Whole-genome sequencing–based laboratory investigations enabled prompt tracing of linked cases to improve tuberculosis control