title: The strength of coughing may forecast the likelihood of spread of multi-drug resistant microorganisms from the respiratory tract of colonized patients.
abstract: BACKGROUND
  Current recommendations indicate that patients who are coughing and have multidrug resistant microorganisms (MDROs) in their sputum are considered to be shedders and should be cared for in single room isolation at least until symptoms resolve. Airborne spread and subsequent contamination of surfaces adjacent to patients may contribute to transmission. Hence, isolation measures for patients colonized or infected with MDRO at their respiratory tract are intended to interrupt such transmission. However, the potential for microbial shedding in patients with MDRO-positive microbiological reports from their respiratory tract and factors justifying the need for single room isolation are viewed controversially.
  
  
  METHODS
  Cough aerosol produced by patients colonized with MDROs was measured for viable counts. Descriptive analysis together with logistic regression analysis was performed to assess the impact of strength of cough on growth of MDRO on culture plates.
  
  
  RESULTS
  In 18% (23/128) MDRO were transmitted. Multivariate analysis revealed that strength of cough significantly predicts the yield of MDRO on culture plates (P = 0.012).
  
  
  CONCLUSIONS
  Based on these results it can be concluded that risk stratification for decision of single room isolation of patients colonized or infected with MDROs at their respiratory tract may also take the severity of cough into consideration. However, more work is required in order to assess the severity of cough objectively.
authors.affiliation: Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Magda
authors.initials: M
authors.lastname: Diab-Elschahawi
authors.affiliation: Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Luigi Segagni
authors.initials: LS
authors.lastname: Lusignani
authors.affiliation: Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Starzengruber
authors.affiliation: Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria.
authors.forename: Dieter
authors.initials: D
authors.lastname: Mitteregger
authors.affiliation: Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wagner
authors.affiliation: Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Ojan
authors.initials: O
authors.lastname: Assadian
authors.affiliation: Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Presterl
keywords: Aerogene spread; Cough; Infection Control; Multidrug resistant microorganism; Risk factors; Single room isolation