Stewardship / Resistance Scan for Feb 23, 2022

C diff in hospital rooms
XDR Shigella increase in Europe

Study finds increased risk of C difficile from contaminated hospital rooms

A study conducted at five acute care hospitals adds further evidence of the role the hospital environment plays in Clostridioides difficile infection (CDI), researchers reported today in the American Journal of Infection Control.

An estimated 236,000 healthcare-associated CDI cases occur each year in the United States, and even with thorough cleaning efforts, C difficile spores can persist in hospital rooms for months, posing colonization and infection risks to patients. To examine the risk posed by a previous room occupant with CDI on subsequent room occupants, a team led by researchers from Johns Hopkins University examined all adult inpatients admitted to five acute care hospitals in Maryland and Washington, DC, from July 2016 through December 2018

A room was considered contaminated for each day it was occupied by a patient who was actively infectious, and for 30 days after. Patients were considered exposed to a contaminated room if they had occupied a contaminated room in the preceding 90 or 365 days. The researchers used logistic regression to assess the association of exposure to a contaminated room with CDI diagnosis.

During the study period, 2,128 CDI cases were reported among 218,731 hospital admissions. After controlling for the number of previous admissions and length of stay, patients admitted to a room previously occupied by a patient with CDI had 27% increased odds of subsequently being diagnosed as having CDI if they were exposed within the past 90 days (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.12 to 1.44) and 40% increased odds if they were exposed within 365 days (OR, 1.40; 95% CI, 1.25 to 1.57).

Similarly, cumulative patient-day exposure to previously CDI-positive occupied rooms within both 90 and 365 days was found to be independently significant, with a 4.5% (OR 1.045; 95% CI, 1.03 to 1.06) and 4.2% (OR 1.042; 95% CI, 1.03 to 1.06) increase in odds of CDI with each day of exposure, respectively.

"Our results contribute to the evolving literature on the impact of the hospital environment on the risk of transmission of pathogenic organisms," the authors write. "More studies are needed to better define transmission risks and mitigation strategies."
Feb 23 Am J Infect Control abstract


ECDC reports increase in extensively drug-resistant Shigella in UK, Europe

The European Centre for Disease Prevention and Control (ECDC) is reporting an increase in extensively drug-resistant (XDR) Shigella sonnei infections in the United Kingdom and elsewhere in Europe.

In a rapid risk assessment published today, the ECDC said the increase was first noted by the UK Health Security Agency in late January, when it reported 47 cases of XDR S sonnei from September 2021 through Jan 10, 2022—up from 16 in the previous 4-month period. The UK outbreak strain showed non-susceptibility to penicillins, third-generation cephalosporins, aminoglycosides, tetracyclines, sulfonamide, quinolones, and azithromycin.

On Feb 10, nine European Union/European Economic Activity (EU/EEA) countries (Austria, Belgium, Denmark, France, Germany, Italy, Ireland, Norway, and Spain) reported at least 146 confirmed cases of shigellosis related to the UK cluster. In individual countries, at least 29 isolates have been reported to be genetically linked through whole-genome sequencing, and Austria, Belgium, Denmark, Germany, Norway, and Spain report that all or at least some of the isolates appear to be genetically close to the UK representative sequences.

Shigella transmission occurs via the fecal-oral route, and symptoms of infection include diarrhea, high fever, and stomach cramps. Antibiotics are typically needed only in patients with severe disease or who require hospitalization. Seven of the UK patients and one Italian patient have been hospitalized.

Most of the reported cases are adult men who have sex with men (MSM), some of whom have been infected through sexual transmission. The ECDC says that, because sexual contact networks among some MSM in Europe are highly connected and sometimes involve high-risk sexual practices, the risk of spread among MSM in EU/EEA countries in the coming months is high, particularly with COVID-19 restrictions being lifted.

The agency also notes that while the risk to the non-MSM population is low, opportunities for infection could increase when transmission among MSM is high.
Feb 23 ECDC rapid risk assessment

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