Cross sectional study of multiresistant bacteria in Danish emergency departments: prevalence, patterns and risk factors for colonization (AB-RED project)

Christian B Mogensen,Annmarie T Lassen,Isik S Johansen,Jørn M Møller,Poul Petersen,David Fuglsang-Damgaard,Ulrich S Jensen,Finn Nielsen,Ming Chen,Dan B Petersen,Flemming S Rosenvinge,Marc Ludwig,Helene Skjøt-Arkil,Svend Ellermann-Eriksen,Karen V Andersen

doi:10.1186/s12873-018-0178-1

Abstract

BackgroundMultiresistant bacteria (MRB) is an increasing problem. Early identification of patients with MRB is mandatory to avoid transmission and to target the antibiotic treatment. The emergency department (ED) is a key player in the early identification of patients who are colonized with MRB.There is currently sparse knowledge of both prevalence and risk factors for colonization with MRSA, ESBL, VRE, CPE and CD in acutely admitted patients in Western European countries including Denmark. To develop evidence-based screening tools for identifying carriers of resistant bacteria among acutely admitted patients, systematic collection of information on risk factors and exposures is required. Since a geographical variation is suspected, it is desirable to include emergency departments across the country.The aim of this project is to provide a comprehensive overview of prevalence and risk factors for MRSA, ESBL, VRE, CPE and CD colonization in patients admitted to Danish ED’s. The objectives are to describe the prevalence and demography of resistance, co-infections, to identify risk factors for carrier state and to develop and validate a screening tool for identification of carriers.MethodsMulticenter descriptive and analytic cross-sectional survey from January–May 2018 of around 10.000 acutely admitted patients > 18 years in 8 EDs for carrier state and risk factors for antibiotic resistant bacteria. Information about the background and possible risk factors for carrier status together with swabs from the nose, throat and rectum is collected and analyzed for MRSA, ESBL, VRE, CPE and CD. The prevalence of the resistant bacteria are calculated at hospital level, regional level and national level and described with relation to residency, sex, age and risk factors. A screening model for identification of carrier stage of resistant bacteria is developed and validated.DiscussionThe study will provide the prevalence of colonized patients with resistant bacteria on arrival to the ED and variation in demographic patterns, and will develop a clinical tool to identify certain risk groups. This will enable the clinician to target antibiotic treatments and to reduce the in-hospital spreading of resistant bacteria. This knowledge is important for implementing and evaluating antimicrobial stewardships, screening and infection control strategies.Trial registrationClinicaltrials.gov: NCT03352167 (registration date: 20. November 2017).

Highlights

Multiresistant bacteria (MRB) is an increasing problem
In Denmark, attention has been focused in particular to methicillin resistant Staphylococcus aureus (MRSA), but there has been an increase in the prevalence of extended-spectrum beta-lactamase-producing enterobacteria (ESBL), vancomycin resistant enterococci (VRE) and carbapenem resistant enterobacteria (CPE) [2]
The consequences of the widespread antibiotic use and increasing bacterial resistance to antibiotics are multiple [3]. Both antibiotic-associated diarrhea caused by infections with toxin-producing Clostridium difficile (CD) [4] and infections and spread of MRB lead to increased healthcare costs, increased morbidity and mortality [5], and complicate advanced treatments that depend on effective infection control, like treatment of malignancies and transplantations [6, 7]

Summary

Methods

The consent includes that the project employee is allowed to obtain a swab from pharynx, nose and rectum, that the microbiological analysis and the exposure information is used for a scientific purpose, and that information concerning antibiotic consumption from the patient records is registered. Throat swabs are collected by rubbing a swab along the mucosal surfaces of the tonsils and pharynx These samples are already collected routinely in Denmark in selected patients who are screened for MRSA, according to the guidelines of the National board of Health. All personal information and project samples are anonymized throughout the study process using a project ID running numbers and the results cannot be seen in the patient file or made available for the clinical care providers.

Discussion

Background

Findings