{"title":"日本一家三级护理医院内及周边设施间的 MRSA、ESBL 大肠杆菌和艰难梭菌传播：基于 PCR 的开放读码框分型分子流行病学研究。","authors":"Hiroki Saito, Satoshi Miike, Tatsuya Ohno, Momoko Anzai, Fumimasa Kasai, Akiko Hosoyama, Tomomi Takakura, Yosuke Tanaka, Shigeki Fujitani","doi":"10.1017/ice.2024.178","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and <i>Clostridioides difficile</i> (<i>C. difficile</i>) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, <i>Pseudomonas aeruginosa</i> with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and <i>C. difficile</i>. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing <i>Escherichia coli</i> (<i>E. coli</i>), and <i>C. difficile</i>, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method.</p><p><strong>Results: </strong>Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL <i>E. coli</i> (31.8%), and 32 ESBL Enterobacterales (non-<i>E. coli</i>) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL <i>E. coli</i> and <i>C. difficile</i> occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively.</p><p><strong>Conclusions: </strong>MDROs/<i>C. difficile</i> transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.</p>","PeriodicalId":13663,"journal":{"name":"Infection Control and Hospital Epidemiology","volume":" ","pages":"1-8"},"PeriodicalIF":3.0000,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Transmission of MRSA, ESBL <i>E. coli</i>, and <i>C. difficile</i> within a tertiary care hospital and across surrounding facilities in Japan: a molecular epidemiological study with the PCR-based Open-reading frame typing.\",\"authors\":\"Hiroki Saito, Satoshi Miike, Tatsuya Ohno, Momoko Anzai, Fumimasa Kasai, Akiko Hosoyama, Tomomi Takakura, Yosuke Tanaka, Shigeki Fujitani\",\"doi\":\"10.1017/ice.2024.178\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and <i>Clostridioides difficile</i> (<i>C. difficile</i>) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Methods: </strong>Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, <i>Pseudomonas aeruginosa</i> with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and <i>C. difficile</i>. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing <i>Escherichia coli</i> (<i>E. coli</i>), and <i>C. difficile</i>, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method.</p><p><strong>Results: </strong>Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL <i>E. coli</i> (31.8%), and 32 ESBL Enterobacterales (non-<i>E. coli</i>) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL <i>E. coli</i> and <i>C. difficile</i> occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively.</p><p><strong>Conclusions: </strong>MDROs/<i>C. difficile</i> transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.</p>\",\"PeriodicalId\":13663,\"journal\":{\"name\":\"Infection Control and Hospital Epidemiology\",\"volume\":\" \",\"pages\":\"1-8\"},\"PeriodicalIF\":3.0000,\"publicationDate\":\"2024-11-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Infection Control and Hospital Epidemiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1017/ice.2024.178\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Infection Control and Hospital Epidemiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1017/ice.2024.178","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Transmission of MRSA, ESBL E. coli, and C. difficile within a tertiary care hospital and across surrounding facilities in Japan: a molecular epidemiological study with the PCR-based Open-reading frame typing.
Objective: To determine the regional impact of transmission of multidrug-resistant organisms (MRDOs) and Clostridioides difficile (C. difficile) among a tertiary care hospital and surrounding facilities including long-term care facilities (LTCFs).
Design: Retrospective cohort study.
Methods: Patients admitted to a tertiary care hospital from July 2019 to July 2021 were recruited if their clinically collected cultures grew the following pathogens: Methicillin-resistant Staphylococcus aureus (MRSA), Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacterales, Pseudomonas aeruginosa with difficult-to-treat resistance, Carbapenem-resistant Enterobaterales, Vancomycin-resistant Enterococci, and C. difficile. Patient characteristics including admission and discharge pathway were collected. For the isolates of MRSA, ESBL-producing Escherichia coli (E. coli), and C. difficile, a molecular epidemiological analysis was conducted, utilizing the PCR-based Open-Reading Frame Typing (POT) method.
Results: Three hundred-five patients were identified with a total of 332 culture specimens of the target pathogens. The top three were 132 MRSA isolates (43.3%, out of 305), 97 ESBL E. coli (31.8%), and 32 ESBL Enterobacterales (non-E. coli) (10.5%). The target pathogens were more detectable within 3 days among patients admitted from LTCFs or other hospitals than those admitted from home (Odds Ratio 4.6, 95% confidence interval 2.8-7.6, p-value < 0.001). The molecular epidemiological analysis suggested the transmissions of MRSA, ESBL E. coli and C. difficile occurred 52 out of 111 patients within the in-hospital environment, and 7 out of 128 within the prehospital environment, respectively.
Conclusions: MDROs/C. difficile transmission is prevalent within a tertiary care hospital and further complicated by its inter-facility transmission across surrounding LTCFs and hospitals in Japan.
期刊介绍：
Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.
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