Infection Control & Hospital Epidemiology (2019), 40,408–413 doi:10.1017/ice.2019.5
Original Article
ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome Aurélien Emmanuel MartinezMD1
Stephan Marsch MD4, Adrian Egli MD2,5 and Sarah Tschudin-Sutter MD1,6 1Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland, 2Clinical Microbiology, University Hospital Basel, Basel, Switzerland, 3Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland, 4Department of Intensive Care Medicine, University Hospital of Basel, Basel, Switzerland, 5Division of Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland and 6Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
Abstract
Objective: To determine whether colonization with extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients. Design: Prospective cohort study. Setting: The 2 ICUs in the University Hospital Basel in Switzerland. Patients: All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours.
Methods: Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of car- bapenem exposure were compared using the Mann-Whitney U test.
Results: Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40–271.41; P=.007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01–5.79; P=.047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3–8 days] vs median, 6 days [IQR 3–9 days]; P=0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44–2.30; P=.993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P=.808).
Conclusions: Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.
(Received 26 October 2018; accepted 29 December 2018)
Extended-spectrum β-lactamases (ESBLs) enable bacteria to hydrolyze penicillins, cephalosporins, and monobactams,1,2 thus conferring resistance to antimicrobials commonly used for empir- ical treatment. Because inadequate empirical antibiotic treatment increases the risk of mortality in patients with sepsis, the emer- gence of ESBL-producing Enterobacteriaceae (ESBL-PE) fosters incremental carbapenem consumption,1 paving the way for carbapenem-resistant bacteria,3 for which hardly any treatment options remain. The rapid emergence of ESBL-PE poses a particular challenge regarding the management of intensive care unit (ICU) patients,
Author for correspondence: Sarah Tschudin-Sutter, Email:
sarah.tschudin@usb.ch PREVIOUSPRESENTATION: Preliminary results of this studywerepresentedas aposter
and as an abstract at the 27th ECCMID European Congress of Clinical Microbiology and Infectious Diseases on April 24, 2017, in Vienna, Austria. Cite this article: Emmanuel Martinez A, et al. (2019). ESBL-colonization at ICU
admission: impact on subsequent infection, carbapenem-consumption, and outcome. Infection Control&Hospital Epidemiology, 40: 408–413,
https://doi.org/10.1017/ice.2019.5
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved.
who are at high risk of developing infections requiring timely and adequate treatment.4–6 Unnecessary exposure to carbapenems in this population, however, may result in increased resistance rates on both individual and institutional levels and may negatively influence individual outcomes.7–9 Colonization with ESBL-PE has been identified as an important
risk factor for invasive infections with ESBL-PE,10–12 and different studies have shown that ICU patients have a particularly high risk of ESBL-PE colonization.13,14 To inform recommendations on empirical use of carbapenems
in the ICU setting, strategies for identifying patients at risk for ESBL-PE are needed. Thus, screening ICU Patients for ESBL-PE carriage on admission is a logical strategy.We sought to determine whether rectal colonization with ESBL-PE on ICU admission predicts the risk for ESBL-PE infection, impacts outcome, and/ or has an effect on subsequent carbapenem prescription in an ICU cohort.
, Andreas WidmerMD1, Reno FreiMD1,2, Hans ParggerMD3, Daniel TuchschererMD3,
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