Efficacy of Admission Screening for Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae
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Authors: | Christopher F Lowe Kevin Katz Allison J McGeer Matthew P Muller for the Toronto ESBL Working Group |
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Institution: | 1. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.; 2. Deparment of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada.; 3. Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.; 4. Division of Infectious Diseases, St. Michael’s Hospital, Toronto, Ontario, Canada.; 5. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.; Amphia Ziekenhuis, The Netherlands, |
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Abstract: | ObjectiveWe hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates.DesignRetrospective cohort study.Setting12 hospitals (6 screening and 6 non-screening) in Toronto, Canada.PatientsAll adult inpatients with an ESBL-E positive culture collected from 2005–2009.MethodsCases were defined as hospital-onset (HO) or community-onset (CO) if cultures were positive after or before 72 hours. Efficacy of screening in reducing HO-ESBL-E incidence was assessed with a negative binomial model adjusting for study year and CO-ESBL-E incidence. The accuracy of the HO-ESBL-E definition was assessed by re-classifying HO-ESBL-E cases as confirmed nosocomial (negative admission screen), probable nosocomial (no admission screen) or not nosocomial (positive admission screen) using data from the screening hospitals.ResultsThere were 2,088 ESBL-E positive patients and incidence of ESBL-E rose from 0.11 to 0.42 per 1,000 inpatient days between 2005 and 2009. CO-ESBL-E incidence was similar at screening and non-screening hospitals but screening hospitals had a lower incidence of HO-ESBL-E in all years. In the negative binomial model, screening was associated with a 49.1% reduction in HO-ESBL-E (p<0.001). A similar reduction was seen in the incidence of HO-ESBL-E bacteremia. When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases.ConclusionsAdmission screening for ESBL-E is associated with a reduced incidence of HO-ESBL-E. Controlled, prospective studies of admission screening for ESBL-E should be a priority. |
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