infection control & hospital epidemiology october 2017, vol. 38, no. 10 original article
Determinants of Implementation of Isolation Precautions Against Infections by Multidrug-Resistant Microorganisms: A Hospital-Based, Multicenter, Observational Study
Thomas Bénet, MD, PhD;1,2 Raphaele Girard, MD;1 Solweig Gerbier-Colomban, MD, PhD;1 Cédric Dananché, PharmD, MSc;1,2 Elisabeth Hodille, PharmD;3 Olivier Dauwalder, PharmD, PhD;3 Philippe Vanhems, MD, PhD1,2
objectives. We aimed to ascertain the factors associated with lack of isolation precautions (IP) in patients infected or colonized by third-generation cephalosporin-resistant Enterobacteriaceae (3GCR-E) and methicillin-resistant Staphylococcus aureus (MRSA) in hospital settings.
design. Prospective surveillance and audit of practices. setting. The study included 4 university hospitals in Lyon, France.
participants. All patients hospitalized between April and June in 2013 and 2015 were included. Case patients had ≥1 clinical sample positive for MRSA and/or 3GCR-E.
methods. Factors associated with the lack of IP implementation were identified using multivariate logistic regression. The incidence of MDRO infections was expressed per 10,000 patient days.
results. Overall, 57,222 patients accounting for 192,234 patient days of hospitalization were included, and 635 (1.1%) MDRO cases were identified. MRSA incidence was 2.5 per 10,000 patient days (95% confidence interval [95% CI], 2.1–3.0) and 3GCR-E incidence was 10.1 per 10,000 patient days (95% CI, 9.2–11.0), with no crude difference between 2013 and 2015 (P=.15 and P=.11, respectively). Among 3GCR-E, the main species were Escherichia coli (43.8%) and Klebsiella pneumoniae (31.0%). Isolation precautions were implemented in 78.5% of cases. Lack of IP implementation was independently associated with patient age, year, specialty, hospital, colonization compared with infection, and lack of medical prescription for IPs (adjusted odds ratio, 17.4; 95% CI, 8.5–35.8; P<.001).
conclusions. MRSA and 3GCR-E infections and/or colonizations are frequent in healthcare settings, and IPs are implemented in most cases. When IPs are lacking, the main factor is the absence of medical prescription for IPs, underscoring the need for alerts to physicians by the microbiological laboratory and/or the infection control team.
Infect Control Hosp Epidemiol 2017;38:1188–1195
Multidrug-resistant microorganisms (MDROs) are a major concern in infection control.1 The 2 most prevalent MDRO in hospital settings are third-generation cephalosporin-resistant Enterobacteriaceae (3GCR-E), typically represented by exten- ded spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) and methicillin-resistant Staphylococcus aureus (MRSA).2 These bacteria induce substantial morbidity and mortality in hospital settings. MRSA bacteremia has been associated with 2-fold increased mortality compared to sensi- tive strains,3 whereas ESBL-E bacteremia has been linked by meta-analysis to 1.85-fold augmented relative risk of death.4 MRSA incidence has decreased in many European countries in
recent years,5,6 and 3GCR-E incidence has increased during the same period.7,8 Similar trends have been observed in the United States9,10 and Asia.11 Contact precautions against MDRO are a major component
of most infection control strategies.12 They are effective in controlling MDRO transmission during hospital outbreaks,13 despite repeated discussion of efficacy, compared to consistent implementation of standard precautions or other measures.14,15 While it has been described in some settings, compliance with isolation precautions (IPs) has been assessed in a nonoutbreak context less frequently. Factors associated with lack of IP implementation could guide future strategies to improve
Affiliations: 1. Service d’Hygiène, Epidémiologie, Infectiovigilance et Prévention, Hospices Civils de Lyon, Lyon, France; 2. Equipe épidémiologie et santé internationale, Laboratoire des Pathogènes Emergents – Fondation Mérieux, Centre International de Recherche en Infectiologie, Inserm U1111, CNRS, UMR 5308, ENS de Lyon, UCBL1, Lyon, France; 3. Laboratoire de Microbiologie, Hospices Civils de Lyon, Lyon, France.
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2017/3810-0008. DOI: 10.1017/ice.2017.153 Received February 8, 2017; accepted June 18, 2017; electronically published July 31, 2017
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