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Epidemiology of Multidrug-Resistant Bacteria in Patients With Long Hospital Stays

Published online by Cambridge University Press:  02 January 2015

Cagri Buke ,
Laurence Armand-Lefevre ,
Isabelle Lolom ,
Waafa Guerinot ,
Claude Deblangy ,
Raymond Ruimy ,
Antoine Andremont  and
Jean-Christophe Lucet
Cagri Buke
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France Ege University Faculty of Medicine, Izmir, Turkey
Laurence Armand-Lefevre
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
Isabelle Lolom
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
Waafa Guerinot
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
Claude Deblangy
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
Raymond Ruimy
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
Antoine Andremont
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
Jean-Christophe Lucet*
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, andParis VII Denis Diderot University, Paris, France
*
Unité d'Hygiène et de Lutte contre l'lnfection Nosocomiale, GH Bichat-Claude Bernard, 75877 Paris Cedex 18, France (jean-christophe.lucet@bch.aphp.fr)
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Abstract

Objective.

To determine rates of colonization with multidrug-resistant (MDR) bacteria (ie, methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant Enterococcus [VRE], extended-spectrum β-lactamase [ESBL]-producing Enterobacteriaceae, and Acinetobacter baumannii) after prolonged hospitalization and to assess the yield of surveillance cultures and variables associated with colonization with MDR bacteria.

Design.

Prospective observational cohort study conducted from February 6 to May 26, 2006.

Methods.

All patients who spent more than 30 days in our university hospital (Paris, France) were included. Rectal and nasal swab samples obtained during day 30 screening were examined for MRSA, VRE, ESBL-producing Enterobacteriaceae, and A. baumannii.

Results.

Of 470 eligible patients, 439 had surveillance culture samples available for analysis, including 51 patients (11.6%) with a history of colonization or infection due to 1 or more types of MDR bacteria (MRSA, recovered from 35 patients; ESBL-producing Enterobacteriaceae, from 16 patients; A. baumannii, from 6 patients; and VRE, from 0 patients) and 37 patients (9.5% of the 388 patients not known to have any of the 4 MDR bacteria before day 30 screening) newly identified as colonized by 1 or more MDR bacteria (MRSA, recovered from 20 patients; ESBL-producing Enterobacteriaceae, from 16 patients; A. baumannii, from 1 patient; and VRE, from 0 patients). A total of 87 (19.8%) of 439 patients were identified as colonized or infected with MDR bacteria at day 30. Factors that differed between patients with and without MRSA colonization included age, McCabe score, comorbidity score, receipt of surgery, and receipt of fluoroquinolone treatment. Patients with ESBL-producing Enterobacteriaceae colonization were younger than patients with MRSA colonization.

Conclusions.

Differences in the variables associated with MRSA colonization and ESBL-producing Enterobacteriaceae colonization suggest differences in the epidemiology of these 2 organisms. Day 30 screening resulted in a 72.5% increase in the number of patients identified as colonized with at least 1 type of MDR bacteria.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 11 , November 2007 , pp. 1255 - 1260
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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