Short reportExtended-spectrum beta-lactamase-producing Enterobacteriaceae carriage upon hospital admission: prevalence and risk factors
Introduction
Antibiotic stewardship and infection control are considered to be the two main strategies to control the spread of multi-drug-resistant bacteria, including extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL).1 However, debate continues regarding the role of patient-to-patient spread, and the effectiveness of infection control in reducing ESBL infections and colonization.2, 3 The use of surveillance depends on several factors, one of which is the proportion of patients that would be missed by relying solely on clinical cultures (undetected ratio). The aim of this study was to assess risk factors for colonization with ESBLs, and to find the undetected ratio of patients carrying ESBLs.
Section snippets
Methods
This prospective cross-sectional study was conducted over one week in April 2011 in a 720-bedded secondary hospital.
All patients, excluding paediatric and obstetric patients, were screened for ESBLs upon admission to hospital. Rectal swabs were collected by nursing staff in the wards.
Results
During the week of the study, 952 patients were admitted to the hospital. Although the intention was to screen all admissions, only 525 patients (55.14%) were screened for ESBLs.
Demographic and clinical data of screened and unscreened patients are shown in Table I.
Of the 525 screened patients, 56 (10.66%) were positive for ESBLs, 41 of which (73.2%) were Escherichia coli. Four of the 56 (7.1%) carriers also had positive ESBL clinical samples during their stay, compared with five of 469 (1.1%)
Discussion
In this study, 10.6% of patients screened on admission were positive for ESBLs. Half of these patients would have remained unidentified without active screening. Four risk factors were identified: nursing home residency, prior antibiotic treatment, hospitalization in the previous year and ESBL carriage. Targeted screening of patients with any of these risk factors meant that screening half of the admitted patients identified 87.5% of those carrying ESBLs. As has been shown for
Conflict of interest statement
None declared.
Funding sources
None.
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