期刊
OPEN FORUM INFECTIOUS DISEASES
卷 7, 期 3, 页码 -出版社
OXFORD UNIV PRESS INC
DOI: 10.1093/ofid/ofaa056
关键词
antibiotic resistance; electronic health records; hospital-acquired infections; nosocomial; pathogen surveillance
资金
- Centers for Disease Control and Prevention (CDC) Epicenters Program [1U54CK000447]
- CDC MInD-Healthcare Program [1U01CK000536]
Background. User- and time-stamped data from hospital electronic health records (EHRs) present opportunities to evaluate how healthcare worker (HCW)-mediated contact networks impact transmission of multidrug-resistant pathogens, such as vancomycin-resistant enterococci (VRE). Methods. This is a retrospective analysis of incident acquisitions of VRE between July 1, 2016 and June 30, 2018. Clinical and demographic patient data were extracted from the hospital EHR system, including all recorded HCW contacts with patients. Contacts by an HCW with 2 different patients within 1 hour was considered a connection. Incident VRE acquisition was determined by positive clinical or surveillance cultures collected >= 72 hours after a negative surveillance culture. Results. There were 2952 hospitalizations by 2364 patients who had >= 2 VRE surveillance swabs, 112 (4.7%) patients of which had incident nosocomial acquisitions. Patients had a median of 24 (interquartile range [IQR], 18-33) recorded HCW contacts per day, 9 (IQR, 5-16) of which, or approximately 40%, were connections that occurred <1 hour after another patient contact. Patients that acquired VRE, had a higher average number of daily connections to VRE-positive patients (3.1 [standard deviation {SD}, 2.4] versus 2.0 [SD, 2.1]). Controlling for other risk factors, connection to a VRE-positive patient was associated with increased odds of acquiring VRE (odds ratio, 1.64; 95% confidence interval, 1.39-1.92). Conclusions. We demonstrated that EHR data can be used to quantify the impact of HCW-mediated patient connections on transmission of VRE, in the hospital. Defining incident acquisition risk of multidrug-resistant organisms through HCWs connections from EHR data in real-time may aid implementation and evaluation of interventions to contain their spread.
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