Air dispersal of multidrug-resistant Acinetobacter baumannii: implication in nosocomial transmission during COVID-19 pandemic

Source avec lien : Journal of Hospital Infection, 2021(116), . 10.1016/j.jhin.2021.08.005

Nous avons décrit la transmission nosocomiale d’Acinetobacter baumannii (MRAB) multirésistant dans un service de neurologie à cubes ouverts et à faible hauteur de plafond, où les isolats de MRAB recueillis dans l’air, dans les objets partagés, sur les surfaces de haut niveau inaccessibles et chez les patients ont été analysés épidémiologiquement et génétiquement par séquençage du génome entier (WGS), ce qui constitue la première étude visant à comprendre la parenté génétique des isolats aériens, environnementaux et cliniques de MRAB dans le cadre d’une épidémie.

We described the nosocomial transmission of multidrug-resistant Acinetobacter baumannii (MRAB) in an open-cubicle neurology ward with low ceiling height, where MRAB isolates collected in air, commonly shared items, non-reachable high-level surfaces and patients were analyzed epidemiologically and genetically by whole genome sequencing (WGS), which is the first study to understand the genetic relatedness of air, environmental, and clinical isolates of MRAB in the outbreak setting. Of 11 highly care dependent patients with 363 MRAB colonization-day during COVID-19 pandemic, ten (90.9%) and 9 (81.8%) had cutaneous and gastrointestinal colonization respectively. Of 160 environmental and air samples, 31 (19.4%) were MRAB-positive. The proportion of MRAB-contaminated commonly shared items was significantly lower in cohort than in non-cohort patient care (0/10,0% vs 12/18,66.7%;p<0.001). Air dispersal of MRAB was consistently detected during but not before diaper change in the cohort cubicle by 25-minute air sampling (4/4,100% vs 0/4,0%;p=0.029). Settle plate method revealed MRAB in 2 samples during diaper change. The proportion of MRAB-contaminated exhaust air grills was significantly higher when the cohort cubicle was occupied by 6 MRAB patients than when <6 patients were cared in the cubicle (5/9,55.6% vs 0/18,0%;p=0.002). The proportion of MRAB-contaminated non-reachable high-level surfaces was also significantly higher when there were ≥3 MRAB patients in the cohort cubicle (8/31,25.8% vs 0/24,0%;p=0.016). WGS revealed clonality of air, environment, and patients’ isolates, suggestive of air dispersal of MRAB. Our findings support the view that that patient cohorting in enclosed cubicles with partition and closed door is preferred if single room is not available. Lisez l’article

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