Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study

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http://hdl.handle.net/10138/224247

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Khawaja , T , Kirveskari , J , Johansson , S , Väisänen , J , Djupsjöbacka , A , Nevalainen , A & Kantele , A 2017 , ' Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study ' , Clinical Microbiology and Infection , vol. 23 , no. 9 . https://doi.org/10.1016/j.cmi.2017.02.003

Title: Patients hospitalized abroad as importers of multiresistant bacteria - a cross-sectional study
Author: Khawaja, T.; Kirveskari, J.; Johansson, S.; Väisänen, J.; Djupsjöbacka, A.; Nevalainen, A.; Kantele, A.
Contributor: University of Helsinki, Infektiosairauksien yksikkö
University of Helsinki, Department of Diagnostics and Therapeutics
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, HUSLAB
University of Helsinki, Clinicum
Date: 2017-09
Language: eng
Number of pages: 8
Belongs to series: Clinical Microbiology and Infection
ISSN: 1198-743X
URI: http://hdl.handle.net/10138/224247
Abstract: Objectives: The pandemic spread of multidrug-resistant (MDR) bacteria poses a threat to healthcare worldwide, with highest prevalence in indigent regions of the (sub) tropics. As hospitalization constitutes a major risk factor for colonization, infection control management in low-prevalence countries urgently needs background data on patients hospitalized abroad. Methods: We collected data on 1122 patients who, after hospitalization abroad, were treated at the Helsinki University Hospital between 2010 and 2013. They were screened for methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii. Risk factors for colonization were explored by multivariate analysis. Results: MDR colonization rates were higher for those hospitalized in the (sub) tropics (55%; 208/377) compared with temperate zones (17%; 125/745). For ESBL-PE the percentages were 50% (190/377) versus 12% (92/745), CPE 3.2% (12/377) versus 0.4% (3/745) and MRSA 6.6% (25/377) versus 2.4% (18/745). Colonization rates proved highest in those returning from South Asia (77.6%; 38/49), followed by those having visited Latin America (60%; 9/16), Africa (60%; 15/25) and East and Southeast Asia (52.5%; 94/179). Destination, interhospital transfer, short time interval to hospitalization, young age, surgical intervention, residence abroad, visiting friends and relatives, and antimicrobial use proved independent risk factors for colonization. Conclusions: Post-hospitalization colonization rates proved higher in the (sub) tropics than elsewhere; 11% (38/333) of carriers developed an MDR infection. We identified several independent risk factors for contracting MDR bacteria. The data provide a basis for infection control guidelines in low-prevalence countries (C) 2017 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.
Subject: Antimicrobial drug resistance
Hospitalization
Infection control
Multidrug resistance
Travel
LACTAMASE-PRODUCING ENTEROBACTERIACEAE
MULTIDRUG-RESISTANT BACTERIA
RISK-FACTORS
INTERNATIONAL TRAVELERS
MULTICENTER COHORT
FOREIGN HOSPITALS
ESCHERICHIA-COLI
COLONIZATION
ENTEROCOCCUS
NETHERLANDS
3121 General medicine, internal medicine and other clinical medicine
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