Table 2. Summary of Best Quality Evidence of Overall Patient-to-Patient Transmission Regardless of Transmission Pathway in Acute-Care Settings First Author, Year Title
Moore C et al 200825
Risk factors for MRSA acquisition in roommate contacts of patients colonized or infected with MRSA in an acute-care hospital
Bloemendaal AL et al 200926
Acquisition and cross transmission of S. aureus in European ICUs
Study Design Population
Retrospective cohort study
326 inpatients who shared a room with a patient who had unrecognized MRSA colonization; 198 completed follow-up
Multicenter cohort study
From 629 screened patients, 316 were at risk of acquiring S. aureus; 45 acquired S. aureus in 6 ICUs in 6 countries
Johnson JK et al 200927
The role of patient-to- patient transmission in the acquisition of IRPA colonization in the ICU
Khandavilli S et al 200928
Utility of spa typing for investigating the local epidemiology of MRSA on a UK ICU
El-Ageery SM et al 201129
The role of HCWs and environment in transmission of MRSA among patients in a MICU in a Saudi hospital
Prospective cohort study
7,071 patients admitted to the medical or surgical ICU; 151 were colonized and 149 acquired IRPA
Prospective clinical study
115 MRSA isolates from ICU patients admitted during a 12-month period
Prospective cohort study
117 MICU patients, 25 HCWs, and 12 environmental sites
Related Objective
To identify risk factors for acquisition of MRSA in patients exposed to an MRSA colonized roommate
To evaluate the cross- transmission rates of both MSSA and MRSA in different ICUs
Related Molecular Analysis
PFGE Transmission Event Definition
Patient acquired a strain indistinguishable from the roommate
Related Finding
25 (12.6%) patients acquired MRSA by 7–10 d after the exposure.
MLVA Spa typing
When a patient acquired a strain that was carried by another patient within the 2 weeks preceding acquisition. Isolates were considered genetically highly related if MLVA and spa type were identical or if isolates differed only in a single locus or had a highly related spa repeat sequence.
To quantify the amount of patient-to-patient transmission versus endogenous acquisitions of IRPA
To assess whether if spa typing can be used to investigate epidemiology of MRSA within a UK ICU, as well as the degree of spread between patients
To determine the clonal relationship and potential routes of transmission of MRSA isolates obtained from patients, HCWs and the environment
PFGE
Isolates were defined as similar on the basis of the PFGE type, and they were defined as epidemiologically related on the basis of any overlap in hospital length of stay.
MLST spa typing
For the patients with the same unusual spa type, epidemiological/ clinical details were used to investigate if patients were present in the ICU concurrently or within 28 days.
PFGE Antibiotyping
Isolates ≥80% similarity were considered to belong to the same pulsotype. Subtypes were assigned to isolates having ≤3 DNA band differences within the same pulsotype.
In 8 of 18 cases (44%), MRSA cross- transmission was identified.
46 (31%) of IRPA acquisitions were defined as cases of patient-to-patient transmission and 28 (19%) were cases of acquisition by the patients’ endogenous flora.
4 (9%) of 45 new MRSA isolates occurring within 28 days of isolation of an unusual spa type that could have been due to cross-transmission
Several HCWs share isolates with the same PFGE patterns (pulsotype A3 and pulsotype C2) as those isolates from patients (P2, 3, 7), thereby establishing the transmission of MRSA between patients and HCWs. Similarly, MRSA isolates obtained from the environmental samples shared the same PFGE pattern (pulsotype A3) as that isolated from 2 patients (P2,7) and 2 HCWs (H1,9).
Irfan S et al 201130 Molecular and epidemiological characterization of clinical isolates of CRAB from public and private sector intensive care units in Karachi, Pakistan
Cross-
sectional study
50 patients admitted to adult ICUs of a private-sector tertiary-care hospital and of a government hospital
To identify molecular and epidemiological characteristics of hospital- acquired CRAB
Sequence- based
multiplex PCR PFGE VTNR
PFGE cluster shared identical or highly similar VNTR profiles
By PFGE, isolates fell into 8 distinct clusters suggesting cross- transmission.
(Continued)
Infection Control & Hospital Epidemiology
453
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122
