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Natural History of Colonization with Gram-Negative Multidrug-Resistant Organisms among Hospitalized Patients

Published online by Cambridge University Press:  02 January 2015

Amy C. Weintrob*
Affiliation:
Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland
Mollie P. Roediger
Affiliation:
Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
Melissa Barber
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, Maryland
Amy Summers
Affiliation:
Microbiology Service, Walter Reed Army Medical Center, Washington, DC
Ann M. Fieberg
Affiliation:
Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota
James Dunn
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
Venus Seldon
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
Fluryanne Leach
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
Xiao-Zhe Huang
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, Maryland
Mikeljon P. Nikolich
Affiliation:
Walter Reed Army Institute of Research, Silver Spring, Maryland
Glenn W. Wortmann
Affiliation:
Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC
*
Infectious Disease Service, Walter Reed Army Medical Center, 6900 Georgia Avenue, NW, Building 2, Ward 63, Room 6312, Washington, DC 20307 (Amy.Weintrob@us.army.mil)

Abstract

Objective.

To determine the anatomic sites and natural history of colonization with gram-negative multidrug-resistant organisms (MDROs).

Design.

Prospective, longitudinal cohort study.

Setting.

Walter Reed Army Medical Center, a 236-bed tertiary care center in Washington, DC.

Patients.

Deployed subjects (ie, inpatients medically evacuated from Iraq or Afghanistan) or nondeployed subjects admitted to the same hospital.

Methods.

Consenting patients had 6 anatomic sites cultured every 3 days for 2 weeks and then weekly. Gram-negative organisms resistant to 3 or more classes of antibiotics were considered MDROs. Isolates were genotyped using pulsed-field gel electrophoresis. Clinical data, data on antibiotic use, and clinical culture results were collected.

Results.

Of 60 deployed subjects, 14 (23%) were colonized with an MDRO at admission, and 13 (22%) had incident colonization during hospitalization. The groin was the most sensitive anatomic site for detecting MDRO colonization, and all but one subject remained colonized for the duration of their hospitalization. Sixty percent of subjects with incident Acinetobacter colonization and 25% of subjects with incident Klebsiella colonization had strains that were related to those isolated from other subjects. Of 60 nondeployed subjects, 5 (8%) were colonized with an MDRO at admission; all had recent healthcare contact, and 1 nondeployed subject had an isolate related to a strain recovered from a deployed subject.

Conclusions.

Colonization with gram-negative MDROs is common among patients with war-related trauma admitted to a military hospital and also occurs among nondeployed patients with recent healthcare contact. The groin is the most sensitive anatomic site for active surveillance, and spontaneous decolonization is rare.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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Footnotes

*

Present affiliation: Uniformed Services University of the Health Sciences, Infectious Disease Clinical Research Program, Bethesda, Maryland, and Infectious Disease Service, Walter Reed Army Medical Center, Washington, DC

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