IAME, UMR 1137, Université Sorbonne Paris Nord, France; Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France; Laboratoire des Agents Pathogènes, Saint-Joseph University of Beirut, Beirut, Lebanon.
Service de Microbiologie Clinique et Unité de Contrôle et de Prévention du Risque Infectieux, Groupe Hospitalier Paris Seine Saint-Denis, AP-HP, 125 Rue de Stalingrad, 93000, Bobigny, France.
J Hosp Infect. 2021 May;111:155-161. doi: 10.1016/j.jhin.2021.01.029. Epub 2021 Feb 10.
Substantial scientific evidence shows that contamination of environmental surfaces in hospitals plays an important role in the transmission of multidrug-resistant organisms (MDROs). To date, studies have failed to identify the risk factors associated with environmental contamination.
To evaluate, compare, and identify factors associated with environmental contamination around carriers of different MDROs.
This was a prospective cohort study from May 2018 to February 2020. A total of 125 patients were included, having been admitted to Avicenne Hospital and Hotel Dieu de France de Beyrouth Hospital who were faecal carriers of MDROs (extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE), carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant enterococci (VRE)). For each patient, quantification of MDRO in stool was undertaken, plus a qualitative evaluation of the presence of MDRO in six different environmental sites; and clinical data were collected.
MDROs comprised ESBL-PE (34%), CPE (45%), and VRE (21%). The most frequent MDRO species was Escherichia coli. Contamination of at least one environmental site was observed for 22 (18%) patients. Only carriage of VanA was associated with a significantly higher risk of dissemination. Having a urinary catheter, carriage of OXA48 and E. coli were protective factors against environmental contamination. There were no significant differences in environmental contamination between E. coli and other Enterobacterales or between ESBL-PE and CPE.
Hospital environmental contamination rates are substantially higher for patients with VRE, compared to the low environment dissemination rates around ESBL-PE and CPE. Further studies on a larger scale are needed to confirm the validity of our findings.
大量科学证据表明，医院环境表面的污染在多重耐药菌（MDRO）的传播中起着重要作用。迄今为止，研究未能确定与环境污染相关的危险因素。
评估、比较和确定不同 MDRO 携带者周围环境污染的相关因素。
这是一项 2018 年 5 月至 2020 年 2 月的前瞻性队列研究。共纳入 125 名患者，他们在贝鲁特阿维森纳医院和法国圣母医院被诊断为 MDRO（产超广谱β-内酰胺酶肠杆菌科（ESBL-PE）、产碳青霉烯酶肠杆菌科（CPE）、万古霉素耐药肠球菌（VRE））的粪便携带者。对每位患者进行粪便中 MDRO 的定量检测，以及对六个不同环境部位 MDRO 存在的定性评估，并收集临床数据。
MDRO 包括 ESBL-PE（34%）、CPE（45%）和 VRE（21%）。最常见的 MDRO 种类是大肠埃希菌。22 名（18%）患者至少有一个环境部位受到污染。只有携带 VanA 与传播的风险显著增加相关。携带尿导管、携带 OXA48 和大肠埃希菌是防止环境污染的保护因素。在大肠埃希菌和其他肠杆菌科之间，以及在 ESBL-PE 和 CPE 之间，环境污染没有显著差异。
与 ESBL-PE 和 CPE 相比，VRE 患者的医院环境污染率要高得多。需要进一步进行更大规模的研究来验证我们的研究结果。
