The Journal of hospital infection · 2026
Drivers and multi-modal containment of hospital-acquired multi-drug-resistant bacterial outbreaks: a systematic review.
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Gao Q, Guo K, He Y, Zhang S, Zhang Y, Cai L, Fan Y, Wang Y
Аннотация
OBJECTIVE: The aims of this study were to delineate the epidemiological trends of hospital-acquired multi-drug-resistant organism (MDRO) outbreaks, identify risk clusters and contributing factors, and evaluate the synergistic efficacy of multi-modal containment strategies.
METHODS: A systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up to July 2025. Original reports of bacterial MDRO-related nosocomial outbreaks in inpatient settings were included. Methodological quality and risk of bias were rigorously assessed via non-randomized studies. A multiple correspondence analysis was used to explore risk factor co-occurrence, and UpSet plot was used to visualize the combinatorial efficacy of infection control measures.
RESULTS: Outbreaks analysed in 125 studies from 1995 to 2023 occurred predominantly in intensive care and neonatal units, showing distinct urban clustering, with bacteria resistant to carbapenem and Gram-negative pathogens as the primary threat. Outbreaks stemmed from synergistic failures involving invasive procedures, system saturation, and environmental reservoirs. Control was invariably multi-modal. Universal measures (100.0%, N = 125/125) included contact isolation and hand hygiene. The main intervention pattern (21.6%, N = 27/125) comprised a core of six components including training, cleaning, homology analysis, and rational antibiotic use. A broader bundle containing nine components (18.4%, N = 23/125) added personal protection, equipment management, and environmental surveillance. Ward closure was the definitive strategy for refractory outbreaks.
CONCLUSIONS: This hierarchical framework for managing hospital-acquired MDRO outbreaks may facilitate precision intervention, from fundamental bundles to targeted escalation, providing a robust clinical template for optimizing nosocomial infection control.
METHODS: A systematic literature search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up to July 2025. Original reports of bacterial MDRO-related nosocomial outbreaks in inpatient settings were included. Methodological quality and risk of bias were rigorously assessed via non-randomized studies. A multiple correspondence analysis was used to explore risk factor co-occurrence, and UpSet plot was used to visualize the combinatorial efficacy of infection control measures.
RESULTS: Outbreaks analysed in 125 studies from 1995 to 2023 occurred predominantly in intensive care and neonatal units, showing distinct urban clustering, with bacteria resistant to carbapenem and Gram-negative pathogens as the primary threat. Outbreaks stemmed from synergistic failures involving invasive procedures, system saturation, and environmental reservoirs. Control was invariably multi-modal. Universal measures (100.0%, N = 125/125) included contact isolation and hand hygiene. The main intervention pattern (21.6%, N = 27/125) comprised a core of six components including training, cleaning, homology analysis, and rational antibiotic use. A broader bundle containing nine components (18.4%, N = 23/125) added personal protection, equipment management, and environmental surveillance. Ward closure was the definitive strategy for refractory outbreaks.
CONCLUSIONS: This hierarchical framework for managing hospital-acquired MDRO outbreaks may facilitate precision intervention, from fundamental bundles to targeted escalation, providing a robust clinical template for optimizing nosocomial infection control.