Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae

• Published in: PloS one 2013-04, Vol.8 (4), p.e62678-e62678
• Main Authors: Lowe, Christopher F, Katz, Kevin, McGeer, Allison J, Muller, Matthew P
• Format: Article
• Language: English
• Subjects: Bacteremia; beta-Lactamases - biosynthesis; Biology; Canada - epidemiology; Clinical isolates; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Disease control; E coli; Enterobacteriaceae; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Epidemics; Escherichia coli; Health surveillance; Hospitals; Hospitals - statistics & numerical data; Humans; Incidence; Infections; Intensive care; Klebsiella pneumoniae; Laboratories; Mass Screening; Medical screening; Medicine; Multidrug resistant organisms; Nosocomial infection; Patient Admission - statistics & numerical data; Patients; Public health; Rectum - microbiology; Staphylococcus aureus; Systematic review; Working groups; β Lactamase
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0062678

We hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates. Retrospective cohort study. 12 hospitals (6 screening and 6 non-screening) in Toronto, Canada. All adult inpatients with an ESBL-E positive culture collected from 2005-2009. Cases 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. There 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