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Dynamics of intraoperative Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter transmission

Published:February 03, 2018DOI:https://doi.org/10.1016/j.ajic.2017.10.018

      Highlights

      • Acinetobacter spp are more likely to be isolated from anesthesia provider hands.
      • Enterobacter spp are more likely to be isolated from patient skin sites.
      • Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter epidemiologically related transmission events often involve anesthesia provider hands.
      • Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter pathogens are frequently transmitted between operating room environments.

      Background

      Our primary objective was to examine anesthesia work area reservoir isolation of Klebsiella, Acinetobacter, Pseudomonas, and Enterobacter spp (KAPE) pathogens. This is a retrospective analysis of a randomized, prospective, and observational study involving 3 academic medical centers.

      Methods

      Patients included adults undergoing general anesthesia. Gram-negative isolates (N = 2,682) were collected from anesthesia work area reservoirs in 274 randomly selected operating room case pairs. Nine hundred and forty-five isolates were included in this study. Chi square tests were used to examine the association of anesthesia work area reservoirs with KAPE genera isolation.

      Results

      Acinetobacter pathogens were more likely to be isolated from anesthesia provider hands (risk ratio [RR], 1.07; 95% confidence interval [CI], 1.04-1.10; corrected P = .004) and less likely to be isolated from patients (RR, 0.2; 95% CI, 0.08-0.50; corrected P < .0001). Enterobacter pathogens were more likely to be isolated from patients (RR, 3.34; 95% CI, 1.92-5.81; corrected P = 0.001) and less likely to be isolated from provider hands (RR, 0.89; 95% CI, 0.83-0.97; corrected P = .007).

      Conclusions

      Anesthesia provider hands are important reservoirs for Acinetobacter spp, whereas patient skin surfaces are key reservoirs for Enterobacter spp. Future work should examine the impact of a multimodal program in controlling the intraoperative spread of Acinetobacter and Enterobacter pathogens.

      Key Words

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