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Biehl LM, Higgins PG, Stemler J, et al. Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016. Euro Surveill. 2022;27(2)doi: 10.2807/1560-7917.ES.2022.27.2.2001876.
Biehl, L. M., Higgins, P. G., Stemler, J., Gilles, M., Peter, S., Dörfel, D., Vogel, W., Kern, W. V., Gölz, H., Bertz, H., Rohde, H., Klupp, E. M., Schafhausen, P., Salmanton-García, J., Stecher, M., Wille, J., Liss, B., Xanthopoulou, K., Zweigner, J., Seifert, H., & Vehreschild, M. J. G. T. (2022). Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016. Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin, 27(2), . https://doi.org/10.2807/1560-7917.ES.2022.27.2.2001876
Biehl, Lena M, et al. "Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016." Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin vol. 27,2 (2022). doi: https://doi.org/10.2807/1560-7917.ES.2022.27.2.2001876
Biehl LM, Higgins PG, Stemler J, Gilles M, Peter S, Dörfel D, Vogel W, Kern WV, Gölz H, Bertz H, Rohde H, Klupp EM, Schafhausen P, Salmanton-García J, Stecher M, Wille J, Liss B, Xanthopoulou K, Zweigner J, Seifert H, Vehreschild MJGT. Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016. Euro Surveill. 2022 Jan;27(2). doi: 10.2807/1560-7917.ES.2022.27.2.2001876. PMID: 35027104.
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Euro Surveill. 2022 Jan;27(2). doi: 10.2807/1560-7917.ES.2022.27.2.2001876.

Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016.

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin

Lena M Biehl, Paul G Higgins, Jannik Stemler, Meyke Gilles, Silke Peter, Daniela Dörfel, Wichard Vogel, Winfried V Kern, Hanna Gölz, Hartmut Bertz, Holger Rohde, Eva-Maria Klupp, Philippe Schafhausen, Jon Salmanton-García, Melanie Stecher, Julia Wille, Blasius Liss, Kyriaki Xanthopoulou, Janine Zweigner, Harald Seifert, Maria J G T Vehreschild

Affiliations

  1. Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
  2. German Centre for Infection Research, partner site Bonn-Cologne, Germany.
  3. Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.
  4. Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany.
  5. German Centre for Infection Research, partner site Tübingen, Germany.
  6. Department of Haematology, Oncology and Immunology, Siloah hospital, Hannover, Germany.
  7. Department of Oncology, Haematology, Immunology and Rheumatology, Internal Medicine II, University Hospital Tübingen, Tübingen, Germany.
  8. Division of Infectious Diseases, Department of Medicine II, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  9. Institute for Medical Microbiology and Hygiene, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  10. Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
  11. Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany.
  12. German Centre for Infection Research, partner site Hamburg-Lübeck-Borstel, Germany.
  13. Department of Oncology and Haematology, Hubertus Wald Tumorzentrum/University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
  14. Department I of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany.
  15. Department of Internal medicine I, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany.
  16. Department of Hospital Hygiene and Infection Control, University Hospital of Cologne, Cologne, Germany.
  17. Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany.

PMID: 35027104 DOI: 10.2807/1560-7917.ES.2022.27.2.2001876

Abstract

BackgroundEvidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.AimWe assessed the impact of SCP on haVRE and their transmission.MethodsWe conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis.ResultsWe included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35-2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59-12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46-3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14-2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33-2.34).ConclusionsWe show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.

Keywords: immunocompromised host; infection control; molecular epidemiology; single room contact precautions; transmission; vancomycin-resistant enterococci

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