Abstract
IntroductionIdentification of third-generation, cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; however, little is known about its effectiveness. The aim of this study was to evaluate the impact of ‘targeted screening’ at patient admission to intensive care units (ICUs) on the incidence of 3GC-RE hospital-acquired infections (HAIs) and compare it to ‘universal screening’.MethodsWe undertook a quasi-experimental study of two ICUs (unit A: intervention group; unit B: control group) at a university-affiliated hospital between 1 January 2008 and 31 December 2011. In unit A, patients were screened universally for 3GC-RE at admission during period 1 (1 January 2008 through 30 September 2010). During period 2 (2011 calendar year), the intervention was implemented in unit A; patients transferred from another unit or hospital were screened selectively. In unit B, all patients were screened throughout periods 1 and 2. 3GC-RE-related HAI incidence rates were expressed per 1,000 patient-days. Incidence rate ratios (IRRs) were examined by multivariate Poisson regression modelling.ResultsIn unit A, 3GC-RE-related HAI incidence rates decreased from 5.4 (95% confidence interval (CI), 4.1 to 7.0) during period 1 to 1.3 (95% CI, 0.5 to 2.9) during period 2 (P < 0.001). No changes were observed in unit B between periods 1 and 2 (P = 0.5). In unit A, the adjusted incidence of 3GC-RE-related HAIs decreased in period 2 compared with period 1 (adjusted IRR, 0.3; 95% CI, 0.1 to 0.9; P = 0.03) independently of temporal trend, trauma and age. No changes were seen in unit B (P = 0.4). The total number of rectal swabs taken showed an 85% decrease in unit A between period 1 and 2 (P < 0.001).ConclusionsTargeted screening of 3GC-RE carriers at ICU admission was not associated with an increase in 3GC-RE-related HAI incidence compared with universal screening. Total number of rectal swabs decreased significantly. These findings suggest that targeted screening may be worth assessing as an alternative to universal screening.
Highlights
Identification of third-generation, cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; little is known about its effectiveness
Identification of Third-generation cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks in Intensive care unit (ICU); unlike methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus [30,31], little is known about its effectiveness [12]
Nearly three-fourths of patients who tested positive for 3GC-RE at admission and became infected by 3GC-RE during their hospitalization were transferred from another hospitalization unit. These results reveal that targeted screening at admission decreased the workload of ICU staff and permitted them to target those patients at greatest risk for 3GC-RE infection among all patients colonized by C3G-RE at admission
Summary
Identification of third-generation, cephalosporin-resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; little is known about its effectiveness. The aim of this study was to evaluate the impact of ‘targeted screening’ at patient admission to intensive care units (ICUs) on the incidence of 3GC-RE hospital-acquired infections (HAIs) and compare it to ‘universal screening’. Third-generation cephalosporin-resistant Enterobacteriaceae (3GC-RE), and extended-spectrum βlactamase-producing Enterobacteriaceae (ESBL-E), have become a global concern since the beginning of the 21st century [1]. The incidence of ESBL-E has increased in both community and hospital settings [2]. The European Antimicrobial Surveillance Network has reported major increases of third-generation cephalosporin-resistant Escherichia coli proportions in health care institutions, ranging from 1.7% in 2002 to 8% in 2009 [3]. Control of ESBL-E spread is urgently required [6]
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