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Quantifying Hospital-Acquired Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Patients in Dutch Hospitals

  • Marjolein F. Q. Kluytmans-van den Bergh (a1) (a2) (a3), Suzan P. van Mens (a4), Manon R. Haverkate (a3), Martin C. J. Bootsma (a3) (a5), Jan A. J. W. Kluytmans (a2) (a3), Marc J. M. Bonten (a3) (a4) and for the SoM Study Group and the R-GNOSIS Study Group...

Abstract

BACKGROUND

Extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-E) are emerging worldwide. Contact precautions are recommended for known ESBL-E carriers to control the spread of ESBL-E within hospitals.

OBJECTIVE

This study quantified the acquisition of ESBL-E rectal carriage among patients in Dutch hospitals, given the application of contact precautions.

METHODS

Data were used from 2 cluster-randomized studies on isolation strategies for ESBL-E: (1) the SoM study, performed in 14 Dutch hospitals from 2011 through 2014 and (2) the R-GNOSIS study, for which data were limited to those collected in a Dutch hospital in 2014. Perianal cultures were obtained, either during ward-based prevalence surveys (SoM), or at admission and twice weekly thereafter (R-GNOSIS). In both studies, contact precautions were applied to all known ESBL-E carriers. Estimates for acquisition of ESBL-E were based on the results of admission and discharge cultures from patients hospitalized for more than 2 days (both studies) and a Markov chain Monte Carlo (MCMC) model, applied to all patients hospitalized (R-GNOSIS).

RESULTS

The absolute risk of acquisition of ESBL-E rectal carriage ranged from 2.4% to 2.9% with an ESBL-E acquisition rate of 2.8 to 3.8 acquisitions per 1,000 patient days. In addition, 28% of acquisitions were attributable to patient-dependent transmission, and the per-admission reproduction number was 0.06.

CONCLUSIONS

The low ESBL-E acquisition rate in this study demonstrates that it is possible to control the nosocomial transmission of ESBL in a low-endemic, non-ICU setting where Escherichia coli is the most prevalent ESBL-E and standard and contact precautions are applied for known ESBL-E carriers.

TRIAL REGISTRATION

Nederlands Trialregister, NTR2799, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2799; ISRCTN Registry, ISRCTN57648070, http://www.isrctn.com/ISRCTN57648070

Infect Control Hosp Epidemiol 2018;39:32–39

Copyright

Corresponding author

Address correspondence to Marjolein Kluytmans-van den Bergh, Amphia Academy Infectious Disease Foundation, Amphia Hospital, PO Box 90158, 4800 RK Breda, the Netherlands (marjoleinkluytmans@gmail.com.)

Footnotes

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Present affiliation: Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, the Netherlands.

a

Authors of equal contribution.

b

SoM study group: Marc Bonten, University Medical Center Utrecht, Utrecht, the Netherlands; Martin Bootsma, University Medical Center Utrecht, Utrecht, the Netherlands; Els de Brauwer, Atrium Medical Center, Heerlen, the Netherlands; Patricia Bruijning-Verhagen, University Medical Center Utrecht, Utrecht, the Netherlands; Anton Buiting, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands; Bram Diederen, Red Cross Hospital, Beverwijk, the Netherlands; Erika van Elzakker, Haga Hospital, Den Haag, the Netherlands; Alexander Friedrich, University Medical Center Groningen, Groningen, the Netherlands; Joost Hopman, University Medical Center St Radboud, Nijmegen, the Netherlands; Greetje Kampinga, University Medical Center Groningen, Groningen, the Netherlands; Peter van Keulen, Amphia Hospital, Breda, the Netherlands; Jan Kluytmans, Amphia Hospital, Breda, the Netherlands, and University Medical Center Utrecht, Utrecht, the Netherlands; Marjolein Kluytmans-van den Bergh, University Medical Center Utrecht, Utrecht, the Netherlands, and Amphia Hospital, Breda, the Netherlands; Nashwan al Naiemi, Ziekenhuisgroep Twente, Almelo/Hengelo, the Netherlands; Guy Oudhuis, Maastricht University Medical Center, Maastricht, the Netherlands; Erwin Raangs, University Medical Center Groningen, Groningen, the Netherlands; Sigrid Rosema, University Medical Center Groningen, Groningen, the Netherlands; John Rossen, University Medical Center Groningen, Groningen, the Netherlands; Gijs Ruijs, Isala Clinics, Zwolle, the Netherlands; Paul Savelkoul, Maastricht University Medical Center+, Maastricht, the Netherlands; Annet Troelstra, University Medical Center Utrecht, Utrecht, the Netherlands; Christina Vandenbroucke-Grauls, VU University Medical Center, Amsterdam, the Netherlands; Kees Verduin, Amphia Hospital, Breda, the Netherlands; Carlo Verhulst, Amphia Hospital, Breda, the Netherlands; Margreet Vos, Erasmus Medical Center, Rotterdam, the Netherlands; Andreas Voss, University Medical Center St Radboud, Nijmegen, the Netherlands; Rob Willems, University Medical Center Utrecht, Utrecht, the Netherlands; Ina Willemsen, Amphia Hospital, Breda, the Netherlands.

c

R-GNOSIS study group: Hetty Blok, University Medical Center Utrecht, Utrecht, the Netherlands; Marc Bonten, University Medical Center Utrecht, Utrecht, the Netherlands; Martin Bootsma, University Medical Center Utrecht, Utrecht, the Netherlands; Rafael Canton, Hospital Universitario Ramón y Cajal, Madrid, Spain; Patricia Ruiz Carbajosa, Hospital Universitario Ramón y Cajal, Madrid, Spain; Petra Gastmeier, Charité-University Medicine Berlin, Berlin, Germany; Sonja Hansen, Charité-University Medicine Berlin, Berlin, Germany; Stephan Harbarth, University of Geneva, Geneva, Switzerland; Fieke Kloosterman, University Medical Center Utrecht, Utrecht, the Netherlands; Friederike Maechler, Charité-University Medicine Berlin, Berlin, Germany; Joost Schotsman, University Medical Center Utrecht, Utrecht, the Netherlands.

PREVIOUS PRESENTATION: Preliminary results from this study were presented at ECCMID 2016 on April 11, 2016, Amsterdam, the Netherlands.

Footnotes

References

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