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ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome

Published online by Cambridge University Press:  21 February 2019

Aurélien Emmanuel Martinez Open the ORCID record for Aurélien Emmanuel Martinez [Opens in a new window] ,
Andreas Widmer ,
Reno Frei ,
Hans Pargger ,
Daniel Tuchscherer ,
Stephan Marsch ,
Adrian Egli  and
Sarah Tschudin-Sutter
Aurélien Emmanuel Martinez
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Andreas Widmer
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Reno Frei
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Clinical Microbiology, University Hospital Basel, Basel, Switzerland
Hans Pargger
Affiliation:
Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland
Daniel Tuchscherer
Affiliation:
Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland
Stephan Marsch
Affiliation:
Department of Intensive Care Medicine, University Hospital of Basel, Basel, Switzerland
Adrian Egli
Affiliation:
Clinical Microbiology, University Hospital Basel, Basel, Switzerland Division of Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
Sarah Tschudin-Sutter*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
*
Author for correspondence: Sarah Tschudin-Sutter, Email: sarah.tschudin@usb.ch
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Abstract

Objective:

To determine whether colonization with extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients.

Design:

Prospective cohort study.

Setting:

The 2 ICUs in the University Hospital Basel in Switzerland.

Patients:

All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours.

Methods:

Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test.

Results:

Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40–271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01–5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3–8 days] vs median, 6 days [IQR 3–9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44–2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P = .808).

Conclusions:

Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 4 , April 2019 , pp. 408 - 413
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Preliminary results of this study were presented as a poster and as an abstract at the 27th ECCMID European Congress of Clinical Microbiology and Infectious Diseases on April 24, 2017, in Vienna, Austria.

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