Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.
Infect Control Hosp Epidemiol. 2019 Apr;40(4):447-456. doi: 10.1017/ice.2018.359. Epub 2019 Mar 6.
Prevalence of multidrug-resistant microorganisms (MDROs) continues to increase, while infection control gaps in healthcare settings facilitate their transmission between patients. In this setting, 5 distinct yet interlinked pathways are responsible for transmission. The complete transmission process is still not well understood. Designing and conducting a single research study capable of investigating all 5 complex and multifaceted pathways of hospital transmission would be costly and logistically burdensome. Therefore, this scoping review aims to synthesize the highest-quality published literature describing each of the 5 individual potential transmission pathways of MDROs in the healthcare setting and their overall contribution to patient-to-patient transmission.
In 3 databases, we performed 2 separate systematic searches for original research published during the last decade. The first search focused on MDRO transmission via the HCW or the environment to identify publications studying 5 specific transmission pathways: (1) patient to HCW, (2) patient to environment, (3) HCW to patient, (4) environment to patient, and (5) environment to HCW. The second search focused on overall patient-to-patient transmission regardless of the transmission pathway. Both searches were limited to transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant A. baumannii, and carbapenem-resistant Enterobacteriaceae. After abstract screening of 5,026 manuscripts, researchers independently reviewed and rated the remaining papers using objective predefined criteria to identify the highest quality and most influential manuscripts.
High-quality manuscripts were identified for all 5 routes of transmission. Findings from these studies were consistent for all pathways; however, results describing the routes from the environment/HCW to a noncolonized patient were more limited and variable. Additionally, most research focused on MRSA, instead of other MDROs. The second search yielded 10 manuscripts (8 cohort studies) that demonstrated the overall contribution of patient-to-patient transmission in hospitals regardless of the transmission route. For MRSA, the reported cross-transmission was as high as 40%.
This scoping review brings together evidence supporting all 5 possible transmission pathways and illustrates the complex nature of patient-to-patient transmission of MDROs in hospitals. Our findings also confirm that transmission of MDROs in hospitals occurs frequently, suggesting that ongoing efforts are necessary to strengthen infection prevention and control to prevent the spread of MDROs.
多药耐药微生物（MDRO）的患病率持续上升，而医疗机构中的感染控制漏洞则促进了它们在患者之间的传播。在这种情况下，有 5 种不同但相互关联的途径负责传播。整个传播过程仍未被很好地理解。设计和进行一项能够研究医疗机构中 MDRO 传播的所有 5 种复杂和多方面途径的单一研究将是昂贵且繁琐的。因此，本范围综述旨在综合描述医疗机构中 MDRO 传播的 5 种潜在途径中的每一种途径的高质量已发表文献，并了解它们对患者之间传播的总体贡献。
我们在 3 个数据库中进行了 2 次独立的系统检索，以查找过去 10 年发表的原始研究。第一次搜索侧重于 HCW 或环境中 MDRO 传播，以确定研究 5 种特定传播途径的出版物：（1）患者到 HCW，（2）患者到环境，（3）HCW 到患者，（4）环境到患者，和（5）环境到 HCW。第二次搜索侧重于无论传播途径如何，患者之间的整体传播。两次搜索都仅限于耐甲氧西林金黄色葡萄球菌（MRSA）、万古霉素耐药肠球菌、多药耐药鲍曼不动杆菌和碳青霉烯类耐药肠杆菌科的传播。在对 5026 篇摘要进行筛选后，研究人员使用客观的预设标准独立审查和评估其余论文，以确定最高质量和最有影响力的论文。
确定了所有 5 种传播途径的高质量论文。这些研究的结果对所有途径都是一致的；然而，描述环境/HCW 到非定植患者的途径的结果更为有限和多变。此外，大多数研究都集中在 MRSA 上，而不是其他 MDRO。第二次搜索产生了 10 篇论文（8 项队列研究），证明了无论传播途径如何，医院内患者之间传播的总体贡献。对于 MRSA，报告的交叉传播率高达 40%。
本范围综述汇集了支持所有 5 种可能传播途径的证据，并说明了医院内 MDRO 患者之间传播的复杂性质。我们的研究结果还证实，医院中 MDRO 的传播经常发生，这表明需要持续努力加强感染预防和控制，以防止 MDRO 的传播。
