Evaluation of the Swabbing of Disposable Absorbent Incontinence Products for Assessing the Carriage of Multiresistant Enterobacteriaceae in Nursing Home Residents.

Alexis Naf,Marie Decalonne,Sandra Dos Santos,Laurent Mereghetti,Nathalie L Van Der Mee-Marquet

doi:10.3389/fmicb.2017.01858

Abstract

We compared the performance of incontinence product (IP) and rectal swabbing for the detection of multidrug-resistant Enterobacteriaceae (MDRE) carriage in a large multicenter study conducted in February 2017 among the residents of 23 French nursing homes. The study included 547 residents who habitually wore IP, 88 of whom were MDRE carriers (16.1%). Positive results were obtained for both rectal and IP swabs for 64 of these residents, for rectal swabs only for 22 and for IP swabs only for two of these patients. The estimated prevalence of MDRE carriage depended on the type of sample: 15.7% for rectal swabs and 12.1% for IP swabs (p < 0.001). The positive percent agreement was 84.2% and the negative percent agreement was 97.4%. Rectal swabbing remains the best method for detecting MDRE carriage in elderly residents, but our findings provide support for the use of swabs from IP used overnight to increase response rates in MDRE surveys in elderly residents that habitually wear IP, when rectal swabbing is not feasible.

Highlights

The increasing incidence of bloodstream infections caused by extended-spectrum B-lactamaseproducing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) is a source of concern and multidrug-resistant Enterobacteriaceae (MDRE) have become a major public health problem.MDRE carriage among nursing home (NH) residents is favored by the frequent use of broadspectrum antibiotics and the lax application of standard precautions during care activities in these institutions (Montoya et al, 2016)
French guidelines do not recommend the routine screening of NH residents for MDRE carriage, but they do promote the implementation of standard precautions during care, and suggest that barrier precautions should be used during the management of CPE carriers
We provide here the first evaluation of incontinence product (IP) swabbing as a possible alternative to rectal swabbing for the detection of MDRE in NH residents

Summary

Introduction

MDRE carriage among nursing home (NH) residents is favored by the frequent use of broadspectrum antibiotics and the lax application of standard precautions during care activities in these institutions (Montoya et al, 2016). Since 2010, our regional infection control team has been running a specific program for NHs involving (i) the education of healthcare workers about the importance of rational antibiotic use, hygiene procedures, and environment cleansing, (ii) observational studies, and (iii) a once-yearly monitoring of MDRE carriage in a representative panel of residents. The overall goal of this program is to decrease antibiotic selection pressure and limit the transmission of MDRE between residents through improvements in antibiotic use and compliance with standard precautions, during the care of the most dependent residents

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Discussion

Conclusion