Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-22T22:18:15.668Z Has data issue: false hasContentIssue false
  • English
  • Français

Natural History of Colonization with Gram-Negative Multidrug-Resistant Organisms among Hospitalized Patients

Published online by Cambridge University Press:  02 January 2015

Amy C. Weintrob ,
Mollie P. Roediger ,
Melissa Barber ,
Amy Summers ,
Ann M. Fieberg ,
James Dunn ,
Venus Seldon ,
Fluryanne Leach ,
Xiao-Zhe Huang  and
Mikeljon P. Nikolich
...Show all authors
Amy C. Weintrob*
Affiliation:
Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland
Mollie P. Roediger
Affiliation:
Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
Melissa Barber
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, Maryland
Amy Summers
Affiliation:
Microbiology Service, Walter Reed Army Medical Center, Washington, DC
Ann M. Fieberg
Affiliation:
Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
James Dunn
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
Venus Seldon
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
Fluryanne Leach
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
Xiao-Zhe Huang
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, Maryland
Mikeljon P. Nikolich
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, Maryland
Glenn W. Wortmann
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
*
Infectious Disease Service, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Building 2, Ward 63, Room 6312, Washington, DC 20307 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine the anatomic sites and natural history of colonization with gram-negative multidrug-resistant organisms (MDROs).

Design.

Prospective, longitudinal cohort study.

Setting.

Walter Reed Army Medical Center, a 236-bed tertiary care center in Washington, DC.

Patients.

Deployed subjects (ie, inpatients medically evacuated from Iraq or Afghanistan) or nondeployed subjects admitted to the same hospital.

Methods.

Consenting patients had 6 anatomic sites cultured every 3 days for 2 weeks and then weekly. Gram-negative organisms resistant to 3 or more classes of antibiotics were considered MDROs. Isolates were genotyped using pulsed-field gel electrophoresis. Clinical data, data on antibiotic use, and clinical culture results were collected.

Results.

Of 60 deployed subjects, 14 (23%) were colonized with an MDRO at admission, and 13 (22%) had incident colonization during hospitalization. The groin was the most sensitive anatomic site for detecting MDRO colonization, and all but one subject remained colonized for the duration of their hospitalization. Sixty percent of subjects with incident Acinetobacter colonization and 25% of subjects with incident Klebsiella colonization had strains that were related to those isolated from other subjects. Of 60 nondeployed subjects, 5 (8%) were colonized with an MDRO at admission; all had recent healthcare contact, and 1 nondeployed subject had an isolate related to a strain recovered from a deployed subject.

Conclusions.

Colonization with gram-negative MDROs is common among patients with war-related trauma admitted to a military hospital and also occurs among nondeployed patients with recent healthcare contact. The groin is the most sensitive anatomic site for active surveillance, and spontaneous decolonization is rare.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 4 , April 2010 , pp. 330 - 337
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

*

Present affiliation: Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, and Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC

References

1. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resis-tant organisms in healthcare settings, 2006. http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. Accessed June 2, 2009.Google Scholar
2. Hidron, AI, Edwards, JR, Patel, J, et al; National Healthcare Safety Network Team; Participating National Healthcare Safety Network Facilities. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare associated infections. Annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007 [published correction appears in Infect Control Hosp Epidemiol 2009;30(1):107]. Infect Control Hosp Epidemiol 2008;29(11):996-1011.Google Scholar
3. Harris, AD, McGregor, JC, Furuno, JP. What infection control interventions should be undertaken to control multidrug-resistant gram-negative bacteria? Clin Infect Dis 2006;43(suppl 2):S57-S61.Google Scholar
4. Pacio, GA, Visintainer, P, Maguire, G, et al. Natural history of colonization with vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilli among long-term care facility residents. Infect Control Hosp Epidemiol 2003;24:246–250.Google Scholar
5. Scanvic, A, Denic, L, Gaillon, S, et al. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:1393–1398.CrossRefGoogle ScholarPubMed
6. Byers, KE, Anglim, AM, Anneski, CJ, Farr, BM. Duration of colonization with vancomycin-resistant Enterococcus . Infect Control Hosp Epidemiol 2002;23:207–211.CrossRefGoogle ScholarPubMed
7. Bradley, SF, Terpenning, MS, Ramsay, MA, et al. Methicillin-resistant Staphylococcus aureus colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle ScholarPubMed
8. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
9. Ostrowsky, BE, Venkataraman, L, D'Agata, EM, et al. Vancomycin-resistant enterococci in intensive care units: high frequency of stool carriage during a non-outbreak period. Arch Intern Med 1999;159:1467–1472.CrossRefGoogle ScholarPubMed
10. Montecalvo, MA, de Lencastre, H, Carraher, M, et al. Natural history of colonization with vancomycin-resistant Enterococcus faecium . Infect Control Hosp Epidemiol 1995;16:680–685.CrossRefGoogle ScholarPubMed
11. Warren, DK, Nitin, A, Hill, C, Fraser, VJ, Kollef, MH. Occurrence of co-colonization or co-infection with vancomycin-resistant enterococci and methicillin-resistant Staphyloccus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2004;25:99–104.Google Scholar
12. Coello, R, Glynn, JR, Gaspar, C, Picazo, JJ, Fereres, J. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA. J Hosp Infect 1997;37:39–46.CrossRefGoogle ScholarPubMed
13. Oethinger, M, Jellen-Ritter, AS, Conrad, S, Marre, R, Kern, WV. Colonization and infection with fluoroquinolone-resistant Escherichia coli among cancer patients: clonal analysis. Infection 1998;26:379–384.Google Scholar
14. Perea, S, Hidalgo, M, Arcediano, A, et al. Incidence and clinical impact of fluoroquinolone-resistant Escherichia coli in the faecal flora of cancer patients treated with high dose chemotherapy and ciprofloxacin prophylaxis. J Antimicrob Chemother 1999;44:117–120.Google Scholar
15. O'Fallon, E, Gautam, S, D'Agata, EMC. Colonization with multidrug-resistant gram-negative bacteria: prolonged duration and frequent co-colonization Clin Infect Dis 2009;48(10:1375–1381.CrossRefGoogle Scholar
16. Lautenbach, E, Tolomeo, P, Mao, X, et al. Duration of outpatient fecal colonization due to Escherichia coli isolates with decreased susceptibility to fluoroquinolones: longitudinal study of patients recently discharged from the hospital. Antimicrob Agents Chemother 2006;50:3939–3943.Google Scholar
17. Harris, AD, Nemoy, L, Johnson, JA, et al. Co-carriage rates of vancomycin-resistant Enterococcus and extended-spectrum beta-lactamase-producing bacteria among a cohort of intensive care unit patients: implications for an active surveillance program. Infect Control Hosp Epidemiol 2004;25(2): 105–108.Google Scholar
18. Bertrand, X, Thouverez, M, Talon, D, et al. Endemicity, molecular diversity, and colonization routes of Pseudomonas aeruginosa in intensive care units. Intensive Care Med 2001;27:1263–1268.Google Scholar
19. Centers for Disease Control and Prevention. PulseNet protocols, http://www.cdc.gov/pulsenet/protocols.htm. Accessed January 2, 2009.Google Scholar
20. Scott, P, Deye, G, Srinivasan, A, et al. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis 2007;44(12:1577–1584.CrossRefGoogle ScholarPubMed
21. Zapor, MJ, Erwin, D, Erowele, G, Wortmann, G. Emergence of multidrug resistance in bacteria and impact on antibiotic expenditure at a major army medical center caring for soldiers wounded in Iraq and Afghanistan. Infect Control Hosp Epidemiol 2008;29:661–663.Google Scholar
22. Sebeny, PJ, Riddle, MS, Petersen, K. Acinetobacter baumannii skin and soft-tissue infection associated with war trauma. Clin Infect Dis 2008;47:444–9.Google Scholar
23. Kader, AA, Kumar, A, Kamath, KA. Fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in patients and asymptomatic healthy individuals. Infect Control Hosp Epidemiol 2007;28:1114–1116.Google Scholar
24. Rodríguez-Baño, J, Alcalá, JC, Cisneros, JM, et al. Community infections caused by extended-spectrum β-lactamase-producing Escherichia coli . Arch Intern Med 2008;168(17:1897–1902.Google Scholar
25. Pitout, JDD, Nordmann, P, Laupland, KB, Poirel, L. Emergence of Enter-obacteriaceae producing extended-spectrum β-lactamases (ESBLs) in the community. J Antimicrob Chemother 2005;56(1):52–59.CrossRefGoogle ScholarPubMed
26. Aronson, NE, Sanders, JW, Moran, KA. In harm's way: infections in deployed American military forces. Clin Infect Dis 2006;43:1045–1051.CrossRefGoogle ScholarPubMed
27. Petersen, K, Riddle, MS, Danko, JR, et al. Trauma related infections in battlefield casualties from Iraq. Ann Surg 2007;245:803–811.Google Scholar
28. Bonomo, RA, Szabo, D. Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa . Clin Infect Dis 2006;43: S49–S56.Google Scholar
29. Agusti, C, Pujol, M, Argerich, MJ, et al. Short-term effect of the application of selective decontamination of the digestive tract on different body site reservoir ICU patients colonized by multi-resistant Acinetobacter baumannii . J Antimicrob Chemother 2002;49:205–208.Google Scholar
30. Ayats, J, Corbella, X, Ardanuy, C, et al. Epidemiological significance of cutaneous, pharyngeal, and digestive tract colonization by multiresistant Acinetobacter baumannii in ICU Patients. J Hosp Infect 1997;37:287–295.Google Scholar
31. Griffith, ME, Ceremuga, JM, Ellis, MW, et al. Acinetobacter skin colonization of US army soldiers. Infect Control Hosp Epidemiol 2006;27:659–661.CrossRefGoogle ScholarPubMed
32. Fournier, PE, Richet, H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42:692–699.Google Scholar
33. Tsai, HT, Wang, JT, Chen, CJ, Chang, SC. Association between antibiotic usage and subsequent colonization or infection of extensive drug-resistant Acinetobacter baumannii: a matched case-control study in intensive care units. Diagn Microbiol Infect Dis 2008;62:298–305.CrossRefGoogle ScholarPubMed
34. Tacconelli, E, Cataldo, MA, De Pascale, G, et al. Prediction models to identify hospitalized patients at risk of being colonized or infected with multidrug-resistant Acinetobacter baumannii calcoaceticus complex. J Antimicrob Chemother 2008;62(5:1130–1137.Google Scholar