Anticipation and Prevention of Antimicrobial-Resistant Bacterial Infection in Severely Ill Hospitalized Patients
AuthorHess, Aaron Stansbury
AdvisorHarris, Anthony D.
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AbstractBackground: Antibiotic-resistant infections are a common complication of hospital care in the United States and associated with increases in cost, length of stay, and mortality. Methods proposed to anticipate and prevent these infections include improved hospital cleaning and the use of prior culture data. Objectives: To test enhanced hospital cleaning as a potential method to reduce patient-to-patient transmission of antibiotic-resistant infections among intensive-care patients, and to evaluate the relationship between prior colonization with antibiotic-resistant bacteria and the subsequent risk of antibiotic-resistant infections among cancer patients. Methods: We tested the effect of enhanced room cleaning on the contamination of healthcare workers' gowns and gloves with antibiotic-resistant bacteria by conducting a cluster-randomized, controlled trial in four intensive care units. The relationship between prior colonization with antibiotic-resistant bacteria and the subsequent risk of antibiotic-resistant infections among cancer patients was assessed with a matched case-control study of cancer patients with suspected infection who subsequently developed an antibiotic-resistant Gram-negative bacteremia. Results: The trial enrolled 142 hospital rooms and sampled 4,444 patient-healthcare worker interactions. Improved room cleaning was associated with a reduction in gown and glove contamination with both methicillin-resistant S. aureus (relative risk: 0.89, 95% confidence interval: 0.50 - 1.53) and multidrug-resistant A. baumannii (relative risk: 0.77, 95% confidence interval: 0.28 - 2.11). In the case-control study of cancer patients with suspected infection, antibiotic-resistant Gram-negative colonization was associated with subsequent antibiotic-resistant Gram-negative bacteremia after exposure to broad-spectrum antibiotics in the previous month (odds ratio: 8.1, 95% confidence interval: 3.6 - 18.0). Conclusion: Improved room cleaning may reduce the risk of patient-to-patient transmission of antibiotic-resistant bacteria in the intensive care setting. Prior colonization with antibiotic-resistant Gram-negative bacteria is a risk factor for subsequent bacteremia among cancer patients, and might be used to guide antibiotic therapy.
DescriptionUniversity of Maryland in Baltimore. Epidemiology and Preventive Medicine. Ph.D. 2012
Cross Infection--prevention & control
Drug Resistance, Bacterial
Intensive Care Units
Methicillin-Resistant Staphylococcus aureus
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/2324
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