Abstract
ObjectiveWe hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates.DesignRetrospective cohort study.Setting12 hospitals (6 screening and 6 non-screening) in Toronto, Canada.PatientsAll adult inpatients with an ESBL-E positive culture collected from 2005–2009.MethodsCases were defined as hospital-onset (HO) or community-onset (CO) if cultures were positive after or before 72 hours. Efficacy of screening in reducing HO-ESBL-E incidence was assessed with a negative binomial model adjusting for study year and CO-ESBL-E incidence. The accuracy of the HO-ESBL-E definition was assessed by re-classifying HO-ESBL-E cases as confirmed nosocomial (negative admission screen), probable nosocomial (no admission screen) or not nosocomial (positive admission screen) using data from the screening hospitals.ResultsThere were 2,088 ESBL-E positive patients and incidence of ESBL-E rose from 0.11 to 0.42 per 1,000 inpatient days between 2005 and 2009. CO-ESBL-E incidence was similar at screening and non-screening hospitals but screening hospitals had a lower incidence of HO-ESBL-E in all years. In the negative binomial model, screening was associated with a 49.1% reduction in HO-ESBL-E (p<0.001). A similar reduction was seen in the incidence of HO-ESBL-E bacteremia. When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases.ConclusionsAdmission screening for ESBL-E is associated with a reduced incidence of HO-ESBL-E. Controlled, prospective studies of admission screening for ESBL-E should be a priority.
Highlights
The proliferation of antibiotic resistant organisms, in particular multi-drug resistant Gram negative organisms, is an emerging public health crisis [1]
In the negative binomial model, screening was associated with a 49.1% reduction in HO-Extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-E) (p,0.001)
When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases
Summary
The proliferation of antibiotic resistant organisms, in particular multi-drug resistant Gram negative organisms, is an emerging public health crisis [1]. Extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBL-E) are a major contributor to this problem due to their increasing incidence, multi-drug resistance and increasing carbapenem use, potentially contributing to the emergence of carbapenem resistant Enterobacteriaceae (CRE) [1,2,3,4]. Despite the importance of this problem, there is little consensus and no definitive guidelines on the optimal infection control interventions to reduce the transmission of endemic ESBL-E in hospitals [5]. One finding of our study was that approximately 50% of hospitals used admission screening to identify patients with ESBL-E [13] This variation in practice provided an opportunity to evaluate the effectiveness of this intervention
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