Journal
ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL
Volume 11, Issue 1, Pages -Publisher
BMC
DOI: 10.1186/s13756-022-01095-x
Keywords
Drug Resistance; multiple; Pseudomonas aeruginosa; Critical care; Epidemiological monitoring; Models; statistical
Categories
Funding
- Innovative Medicines Initiative Joint Undertaking [115737-1]
- European Union [FP 7/2007-2013]
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This study analyzed VIM-PA surveillance data of two intensive-care unit (ICU) wards in Erasmus University Medical Center Rotterdam from 2010 to 2018 using a mathematical transmission model. The results showed that the majority of VIM-PA transmissions in these ICUs were caused by persistent environmental contamination, while only a small proportion were due to direct cross-transmission.
Background Hospital outbreaks of multidrug resistant Pseudomonas aeruginosa are often caused by Pseudomonas aeruginosa clones which produce metallo-beta-lactamases, such as Verona Integron-encoded Metallo-beta-lactamase (VIM). Although different sources have been identified, the exact transmission routes often remain unknown. However, quantifying the role of different transmission routes of VIM-PA is important for tailoring infection prevention and control measures. The aim of this study is to quantify the relative importance of different transmission routes by applying a mathematical transmission model using admission and discharge dates as well as surveillance culture data of patients. Methods We analyzed VIM-PA surveillance data collected between 2010 and 2018 of two intensive-care unit (ICU) wards for adult patients of the Erasmus University Medical Center Rotterdam using a mathematical transmission model. We distinguished two transmission routes: direct cross-transmission and a persistent environmental route. Based on admission, discharge dates, and surveillance cultures, we estimated the proportion of transmissions assigned to each of the routes. Results Our study shows that only 13.7% (95% CI 1.4%, 29%) of the transmissions that occurred in these two ICU wards were likely caused by cross-transmission, leaving the vast majority of transmissions (86.3%, 95% CI 71%, 98.6%) due to persistent environmental contamination. Conclusions Our results emphasize that persistent contamination of the environment may be an important driver of nosocomial transmissions of VIM-PA in ICUs. To minimize the transmission risk from the environment, potential reservoirs should be regularly and thoroughly cleaned and disinfected, or redesigned.
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