Introduction of highly resistant bacteria into a hospital via patients repatriated or recently hospitalized in a foreign country

AbstractWe describe the prevalence of carriage and variables associated with introduction of highly drug-resistant microorganisms (HDRMO) into a French hospital via patients repatriated or recently hospitalized in a foreign country. The prevalence of HDRMO was 11% (15/132), with nine carbapenamase-producing Enterobacteriaceae, nine carbapenem-resistant Acinetobacter baumannii and six glycopeptide-resistant enterococci. Half of the admitted patients (63/132, 48%) were colonized with extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE). Among the four episodes with secondary cases, three involved A. baumannii

J Hosp Infect

Cohorting carbapenemase-producing Enterobacteriaceae (CPE) carriers during hospitalisation limits the in hospital spreading. Our objective was to identify risk factors for CPE acquisition among contacts of an index patient in non-cohorted populations. A multicentre retrospective matched case-control study was conducted in five hospitals. Each contact patient (case) who acquired Klebsiella pneumoniae OXA-48 from an index patient was compared to three contact (controls) with the same index patients matched with hospitalization in the same unit and similar exposure-times. Fifty-one secondary cases and 131 controls were included. By univariate analysis exposure time (OR=1.06; 95% CI = 1.02 - 1.1; p = 0.006), concomitant infection at admission (OR=3.23; 95% CI = 1.42 - 7.35; p = 0.005), antimicrobial therapy within the last month before hospitalization (OR=2.88; 95% CI = 1.34- 6.2; p = 0.007), antimicrobial therapy during the exposure-time (OR=5.36; 95% CI = 2.28 - 12.6; p < 0.001), use of at least one invasive procedure (OR=2.99; 95% CI = 1.25 - 7.15; p = 0.014), number of invasive procedure (OR=1.52; 95%CI = 1.05 - 2.19; p=0.025), and the geographical proximity (OR=2.84; 95% CI = 1.15 - 7.00; p = 0.023) were associated with CPE acquisition. By multivariate analysis, antimicrobial therapy during the exposure-time (OR=6.36; 95% CI = 2.46 - 16.44; p < 0.001), at least one invasive procedure (OR=2.92; 95%CI=1.04-8.17; p=0.041), and geographical proximity (OR=3.69; 95% CI = 1.15 - 11.86; p = 0.028) were associated with acquisition. In this study, geographical proximity, invasive procedure and antimicrobial therapy during exposure-time were significantly associated with KP-OXA-48 acquisition