Assessment of five screening strategies for optimal detection of carriers of third‐generation cephalosporin‐resistant Enterobacteriaceae in intensive care units using daily sampling. (25th July 2014)

• Record Type: Journal Article
• Authors: Grohs, P.; Podglajen, I.; Guerot, E.; Bellenfant, F.; Caumont‐Prim, A.; Kac, G.; Tillecovidin, B.; Carbonnelle, E.; Chatellier, G.; Meyer, G.; Fagon, J.Y.; Gutmann, L.; Cantón, R.
• Is Part Of: Clinical microbiology and infection. Volume 20:Number 11(2014:Nov.)
• Page Start: O879
• Page End: O886
• Publication Date: 2014-07-25
• Subjects: Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1111/1469-0691.12663
• Languages: English
• ISSNs: 1198-743X

Abstract

<abstract abstract-type="main" id="clm12663-abs-0001"> <title>Abstract</title> <p>There is no consensus on optimal screening procedures for multidrug‐resistant <italic>Enterobacteriaceae</italic> (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended‐spectrum beta‐lactamase (ESBL) and high‐level expressed AmpC cephalosporinase (HL‐CASE) producers. During a 3‐month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE‐selective media. Bacteria were identified using MALDI‐TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL‐CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of MDRE detection among the 93 patients (62% vs. 70%). In contrast, screening at admission and discharge, screening at admission and weekly thereafter, and screening at admission and weekly thereafter and at discharge significantly increased MDRE detection (77%, p 0.02; 76%, p 0.01; 86%, p <0.001, respectively). The difference in MDRE detection between these strategies relies essentially on the levels of detection of patients with HL‐CASE producers. The most reasonable strategy would be to collect two samples, one at admission and one at discharge, which would detect 87.5% of the ESBL strains, 67.3% of the HL‐CASE strains and 77.4% of all MDRE strains. This study should facilitate decision‐making concerning the most suitable screening policy for MDRE detection in a given ICU setting.</p> </abstract>