1190 infection control & hospital epidemiology october 2017, vol. 38, no. 10 A descriptive analysis was conducted. Incidence was calculated
per 10,000 patient days of hospitalization. Incidences were compared with a mid-P exact test, and crude incidence ratios were calculated according to the type of
unit.Categorical variables were reported as numbers and percentages and were compared using the χ2 test. Continuous variables were described as mean (±standard deviation) and were compared using the Student t test. The following factors were potentially associated with lack of IP implementation: gender, age (<50 years, 50–59 years, 60–69 years, 70–79 years, ≥80 years), study year (2015 vs 2013), specialty (acute care, intensive care, rehabilitation, extended stay facility, nursing home, or psychiatric facility), hospital center (A, B,C,and D),microorganism,infectionversuscolonization, hospital-acquired versus imported infection, anatomical site (blood, deep wound, pulmonary protected or nonprotected samples, urine, other), time between admission and onset of infection (day 0, days 1–2, days 3–9, days 10–29, ≥day 30), type of isolation indicated (contact only, contact and droplets, or other), and medical prescription for IPs. After univariate logistic regres- sion analysis of factors associated with lack of IP implementation, variables with P values <.10 were entered in the initial multi- variate model. Variables then underwent backward stepwise deletion with the Wald test until all P values were <.05. Major relevant interactions were also tested; no interaction was finally retained in the multivariate model. All tests were 2-tailed, and P<.05 was considered significant. Analyses were conducted with Stata 13.0 software (StataCorp LP, College Station, TX). The study did not require ethics committee approval because it drew from an observational surveillance database approved under French national regulations (ComitéNational Informatique
et Liberté). The datawere analyzed anonymously, and patient care was not affected.
results
Overall, 57,222 patients were included in the study (29,136 in 2013 and 28,386 in 2015), accounting for 505,947 patient days of hos- pitalization (257,351 patient days in 2013 and 248,616 patient days in 2015). A total of 635MDROcases occurred overall, for a global attack rate of 1.3 (95% confidence interval [95% CI], 1.0–1.2) per 100 patients and an incidence of 12.5 (95% CI, 11.6–13.6)MDRO infections per 10,000 patient days. Crude incidence rates were somewhat stable in 2013 and 2015 for MRSA (P=.28) and 3GCR-E (P=.14; Table 2). The highest incidence ofMDRO was found in intensive care units (ICUs) comparedwith extended-stay facilities and nursing homes. Among MDRO case patients, the male:female ratio was 1.3, and the mean age was 68.2 years (±19.3). Moreover, 268 infections (42.2%) were acquired in a hospital, and 348 infections (54.8%) were imported. Overall, 126 MRSA cases (19.8%) and 509 3GCR-E cases (80.2%) comprised the MDRO burden. The main 3GCR-E species were Escherichia coli (n=223; 43.8%), Klebsiella pneumoniae (n=158; 31.0%), Enterobacter cloacae (n=60; 11.8%), Citrobacter freundii (n=20; 3.9%), and Enterobacter aerogenes (n=16; 3.1%). Urinary tract infections accounted for almost half of MDRO cases (n=316; 49.8%). The other most prevalent infection sites were blood culture (9.9%) and pulmonary (protected) samples (8.5%) and pulmonary (nonprotected) samples (7.1%). Among 3GCR-E, 20 of 509 (2.8%) were also resistant to carbapenems. Table 3 reports the 3GCR-E and MRSA cases
encountered.MRSA differed from
table 2. Incidence of Methicilin-Resistant Staphylococcus aureus (MRSA) and Third-Generation Cephalosporin-Resistant Enterobacter- iaceae (3GCR-E) Infections by Specialty and Year in University of Lyon Hospitals, 2013 and 2015 (n=57,222)
2013 No. of Characteristics
MRSA infections Overall
Short stay
Intensive care Rehabilitation
Extended-stay facility
3GCR-E infections Overall
Short stay
Intensive care Rehabilitation
Extended-stay facility
Infections/No. of Patient Days
73/257,331 40/159,759 15/10,464 13/43,092 4/33,913
Nursing home 0/7,383
242/257,331 150/159,759 53/10,464 33/43,092 6/33,913
Nursing home 0/7,383
Incidence (95% CI)a
No. of
Infections/No. of Patient Days
2.8 (2.2–3.5) 53/248,616 2.5 (1.8–3.4) 35/153,954 14.3 (8.3–23.1) 8/10,198 3.0 (1.7–5.0) 1.2 (0.4–2.8)
6/42,128 3/35,157
0.0 1/7,179
Incidence (95% CI)a
Crude IRRb Valueb P
2.1 (1.6–2.8) 0.82 (0.57–1.20) .28 2.3 (1.6–3.1) 0.91 (0.56–1.47) .68 7.8 (3.6–14.9) 0.55 (0.20–1.37) .17 1.4 (0.6–3.0) 0.47 (0.14–1.33) .13 0.9 (0.2–2.3) 0.72 (0.11–4.28) .69
1.4 (0.07–6.9) NE .49
9.4 (8.3–10.6) 267/248,616 10.7 (9.5–12.1) 1.14 (0.96–1.36) .14 9.4 (8.0–11.0) 170/153,954 11.0 (9.5–12.8) 1.18 (0.94–1.47) .15 50.6 (38.3–65.7) 44/10,198 7.7 (5.4–10.6) 44/42,128 1.8 (0.7–3.7)
0.0
NOTE. CI, confidence interval; IRR, incident rate ratio. aPer 10,000 patient days. b2015 compared with 2013 (reference).
7/35,157 1/7,179
43.1 (31.7–57.4) 0.85 (0.56–1.29) .43 10.4 (7.7–13.9) 1.36 (0.85–2.21) .18 2.0 (0.9–3.9) 1.13 (0.32–4.05) .84
1.4 (0.07–6.9) NE .49 2015 No. of
Infections/No. of Patient Days
126/505,947 75/313,713 23/20,662 19/85,220 7/69,070
1/14,562
97/20,662 77/85,220 13/69,070
Incidence (95% CI)a
2.5 (2.1–3.0) 2.4 (1.9–3.0)
11.1 (7.2–16.4) 2.2 (1.4–3.4) 1.0 (0.4–2.0)
0.7 (0.03–3.4)
509/505,947 10.1 (9.2–11.0) 320/313,713 10.2 (9.1–11.4) 46.9 (38.3–57.0) 9.0 (7.2–11.2) 1.9 (1.0–3.1)
1/14,562 0.7 (0.03–3.4) Overall
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