Improved quality of care for patients infected or colonised with ESBL-producing Enterobacteriaceae in a French teaching hospital: impact of an interventional prospective study and development of specific tools

• Published in: European journal of clinical microbiology & infectious diseases 2018-05, Vol.37 (5), p.977-981
• Main Authors: Mondain, Véronique, Lieutier, Florence, Pulcini, Céline, Degand, Nicolas, Landraud, Luce, Ruimy, Raymond, Fosse, Thierry, Roger, Pierre Marie
• Format: Article
• Language: English
• Subjects: Antibiotics; Biomedical and Life Sciences; Biomedicine; Enterobacteriaceae; Human health and pathology; Infectious diseases; Internal Medicine; Life Sciences; Management; Medical Microbiology; Original Article; Patients; Protocol (computers); Quality assessment; Quality of care; Regional development; Santé publique et épidémiologie; Teaching hospitals; Warning systems
• ISSN: 0934-9723; 1435-4373
• DOI: 10.1007/s10096-018-3234-6

The increasing incidence of ESBL-producing Enterobacteriaceae (ESBL-E) in France prompted the publication of national recommendations in 2010. Based on these, we developed a toolkit and a warning system to optimise management of ESBL-E infected or colonised patients in both community and hospital settings. The impact of this initiative on quality of care was assessed in a teaching hospital. The ESBL toolkit was developed in 2011 during multidisciplinary meetings involving a regional network of hospital, private clinic and laboratory staff in Southeastern France. It includes antibiotic treatment protocols, a check list, mail templates and a patient information sheet focusing on infection control. Upon identification of ESBL-E, the warning system involves alerting the attending physician and the infectious disease (ID) advisor, with immediate, advice-based implementation of the toolkit. The procedure and toolkit were tested in our teaching hospital. Patient management was compared before and after implementation of the toolkit over two 3-month periods (July–October 2010 and 2012). Implementation of the ESBL-E warning system and ESBL-E toolkit was tested for 87 patients in 2010 and 92 patients in 2012, resulting in improved patient management: expert advice sought and followed (16 vs 97%), information provided to the patient’s general practitioner (18 vs 63%) and coding of the condition in the patient’s medical file (17 vs 59%), respectively. Our multidisciplinary strategy improved quality of care for in-patients infected or colonised with ESBL-E, increasing compliance with national recommendations.