157 - patient to Environment Transmission of Multidrug-resistant Bacteria Within Intensive Care Units

Background: Identifying risk factors for environmental contamination with multidrug-resistant organisms (MDROs) is essential to prioritize methods for prevention of hospital transmission.

Methods: Patients admitted to an ICU with an MDRO detected on clinical culture in the prior 30 days were enrolled. Patients (4 body sites) and high-touch objects (HTO) (3 composite sites) in ICU rooms were sampled. Environmental transmission was defined by shared MDRO species cultured on patient and HTO cultures obtained on multiple time points during the patient’s stay. Risk factors for environmental transmission were identified with logistic regression.

Results: Forty-five patients were included (median 2 days of longitudinal sampling [IQR 1-4 days]). Enrollment anatomic cultures included extended-spectrum beta-lactamase-producing Enterobacterales (ESBLE) (n=12, 27%), carbapenem-resistant organisms (CRO) (n=4, 9%), methicillin-resistant S.aureus (MRSA) (n=11, 24%), vancomycin-resistant Enterococci (VRE) (n=4, 9%), and C.difficile (CDIFF) (n=14, 31%). Patient colonization during serial sampling was common with CRO (n=21, 47%), ESBLE (n=16, 36%), and VRE (n=16, 36%) and less so with MRSA (n=7, 16%) and CDIFF (n=5, 11%). Detection of MDROs on environmental surfaces was also common with identification of CRO in 47% of patient rooms (n=21) and ESBLE in 29% (n=13); MRSA (n=2, 4%), VRE (n=9, 20%), and CDIFF (n=3, 7%) were rarer. Patient to environment transmission was observed in 40% of rooms (n=18). Thirteen (29%) rooms had foreign MDRO contamination (i.e., one not detected on a body culture), most (n=10) with CRO.  Environmental MDROs were most common in bathroom/sinks (n=22), followed by surfaces near the patient (n=10), and least common surfaces often touched by staff within the room (n=6). 
 
On multivariable logistic regression, naïve to clustering by patient, recent receipt of a proton pump inhibitor (OR 2.35, 95% CI 1.00 – 5.52, P=0.049) and presence of one or more wounds (OR 2.56, 95% CI 1.05 – 6.26, P=0.038) were significantly associated with environmental transmission (OR 1.56, 95% CI 1.01 – 2.43, P=0.046) (Table 1).Table 1. Logistic regression for detection of patient to environment transmission of multi-drug resistant organisms


Conclusion: MDRO contamination of patient rooms is common with detection of organisms attributed to, and foreign to, the occupant.

Presenting Author(s)

• 

  Matthew J. Ziegler, MD MSCE

  Assistant Professor of Medicine
  University of Pennsylvania
  Philadelphia, PA

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

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Co-Author(s)

• 

  Brendan Kelly, MD, MSCE

  Assistant Professor
  Hospital of the University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Michael Z. David, MD PhD

  Assistant Professor of Medicine
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: GSK (Consultant)
• LD

  Lauren Dutcher, MD

  Instructor of Medicine
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• PT

  Pam C. Tolomeo, MPH, CCRP

  Clinical Research Project Manager
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SB

  Selamawit Bekele, BS

  Research Coordinator
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• SL

  Sean Loughrey, BS

  Research Technician
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• ER

  Emily Reesey, MS

  Laboratory Manager
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• LG

  Laurel Glaser, MD, PhD

  Assistant Professor of Clinical Pathology and Laboratory Medicine
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
• 

  Ebbing Lautenbach, MD, MPH, MSCE

  Professor of Medicine and Epidemiology
  University of Pennsylvania
  Philadelphia, Pennsylvania

  Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.