Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study

被引：43

作者：

Platteel, T. N. ^{[1
,2
]}

Leverstein-van Hall, M. A. ^{[3
,4
]}

Stuart, J. W. Cohen ^{[5
]}

Thijsens, S. F. T. ^{[6
]}

Mascini, E. M. ^{[7
]}

van Hees, B. C. ^{[8
]}

Scharringa, J. ^{[2
]}

Fluit, A. C. ^{[2
]}

Bonten, M. J. M. ^{[2
]}

机构：

[1] Saltro, Dept Med Microbiol, Utrecht, Netherlands

[2] Univ Med Ctr Utrecht, Dept Med Microbiol, NL-3508 GA Utrecht, Netherlands

[3] Bronovo Hosp, Dept Med Microbiol, The Hague, Netherlands

[4] Diaconessenhuis, Leiden, Netherlands

[5] Med Ctr Alkmaar, Dept Med Microbiol, Alkmaar, Netherlands

[6] Diakonessen Hosp, Dept Med Microbiol, Utrecht, Netherlands

[7] Rijnstate Hosp, Dept Med Microbiol, Arnhem, Netherlands

[8] Gelre Hosp, Dept Med Microbiol & Infect Prevent, Apeldoorn, Netherlands

来源：

CLINICAL MICROBIOLOGY AND INFECTION | 2015年 / 21卷 / 02期

关键词：

Carriage; Enterobacteriaceae; ESBL; hospital admission; risk factors; CHANGING EPIDEMIOLOGY; RESISTANT BACTERIA; ESCHERICHIA-COLI; FECAL CARRIAGE; ENTEROBACTERIACEAE; PREVALENCE; COLONIZATION; INFECTIONS;

D O I：

10.1016/j.cmi.2014.09.014

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

The prevalence of patients colonized with extended-spectrum beta-lactamase (ESBL)-producing bacteria increases, especially in long-term-care facilities (LTCFs). Identification of ESBL carriers at hospital admission is relevant for infection control measures and antibiotic therapy for nosocomial infections. We aimed to develop a prediction rule for ESBL carriage at hospital admission for patients admitted from home and LTCFs, and to quantify incidences of nosocomial infections caused by ESBL-producing bacteria. The ESBL-carrier status was determined of patients admitted from LTCFs and from home settings in four hospitals in the Netherlands using perianal swabs obtained within 48 hours of admission. Risk factors for ESBL carriage were assessed. Infections caused by ESBL-producing bacteria were identified retrospectively. Among 1351 patients, 111 (8.2%) were ESBL carriers at admission: 50/579 (8.6%) admitted from LTCFs and 61/772 (7.9%) from home settings (p 0.63). Previous ESBL carriage and previous hospital admission were risk factors for ESBL carriage in multivariable analysis. The area under the curve of the receiver operating characteristic curve of the model was 0.64 (95% CI 0.58-0.71). Presence of >= 1 risk factor (n = 803; 59%) had sensitivity of 72%. Incidences of nosocomial infections caused by ESBL-producing bacteria were 45.5/10 000 and 2.1/10 000 admission days for ESBL carriers and non-carriers, respectively (p <0.05). In conclusion, prevalence of ESBL carriage at hospital admission was 8.2%, and was comparable among patients admitted from LTCF and home. A clinically useful prediction rule for ESBL carriage at admission could not be developed. The absolute incidence of nosocomial infections by ESBL-producing bacteria was low, but higher among patients carrying ESBL-producing bacteria at the time of hospital admission. Clinical Microbiology and Infection (C) 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

引用

页码：141 / 146

页数：6

共 22 条

[21] Population Distribution of Beta-Lactamase Conferring Resistance to Third-Generation Cephalosporins in Human Clinical Enterobacteriaceae in The Netherlands [J].

Voets, Guido M. ;

Platteel, Tamara N. ;

Fluit, Ad C. ;

Scharringa, Jelle ;

Schapendonk, Claudia M. ;

Stuart, James Cohen ;

Bonten, Marc J. M. ;

Leverstein-van Hal, Maurine A. .

PLOS ONE, 2012, 7 (12)

[22] Trends in Human Fecal Carriage of Extended-Spectrum β-Lactamases in the Community: Toward the Globalization of CTX-M [J].

Woerther, Paul-Louis ;

Burdet, Charles ;

Chachaty, Elisabeth ;

Andremont, Antoine .

CLINICAL MICROBIOLOGY REVIEWS, 2013, 26 (04) :744-758

← 1 2 3 →