Admission prevalence of colonization with third-generation cephalosporin-resistant Enterobacteriaceae and subsequent infection rates in a German university hospital

Abstract

BackgroundMany patients admitted to a hospital are already colonized with multi-drug resistant organisms (MDRO) including third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB). The aim of our study was to determine the prevalence of rectal 3GCREB colonization at admission to a large German university hospital and to estimate infection incidences. In addition, risk factors for 3GCREB colonization were identified.Materials/MethodsIn 2014 and 2015, patients were screened for rectal colonization with 3GCREB and filled out a questionnaire on potential risk factors at admission to a non-intensive care unit (non-ICU). All patients were retrospectively monitored for bacterial infections. Descriptive, univariable and multivariable logistic regression analyses were conducted to identify risk factors for 3GCREB colonization at admission.ResultsOf 4,013 patients included, 10.3% (n = 415) were rectally colonized with 3GCREB at admission. Incidence of nosocomial infections was 3.5 (95% CI 2.0–6.1) per 100 patients rectally colonized with 3GCREB compared to 2.3 (95% CI 1.8–3.0, P = 0.213) per 100 3GCREB negative patients.Independent risk factors for 3GCREB colonization were prior colonization / infection with MDRO (OR 2.30, 95% CI 1.59–3.32), prior antimicrobial treatment (OR 1.97, 95% CI 1.59–2.45), male sex (OR 1.38, 95% CI 1.12–1.70), prior travelling outside Europe (OR 2.39, 95% CI 1.77–3.22) and places of residence in the Berlin districts Charlottenburg-Wilmersdorf (OR 1.52, 95% CI 1.06–2.18), Friedrichshain-Kreuzberg (OR 2.32, 95% CI 1.44–3.74) and Mitte (OR 1.73, 95% CI 1.26–2.36).ConclusionsAdmission prevalence of rectal colonization with 3GCREB was high, while infection incidence did not significantly differ between patients rectally colonized or not with 3GCREB at hospital admission. In consequence, hospitals should prioritize improvement of standard precautions including hand hygiene to prevent infections among all patients irrespective of their 3GCREB status at hospital admission.

Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland – a systematic review

“…Data from targeted admission screenings in Switzerland are comparable to numbers in Germany, where similar carriage rates among patients transferred from abroad for resistant Gram-negatives (13% vs. 14-17% in our review) and for MRSA (4% vs. 1-4% in our review) were found [6]. ESBL-prevalence from universal admission screening was 8% in a study included in our review, which is comparable to the 10% prevalence found in a German study [9,59]. One of the most urgent antibiotic resistant threats, coming along with increased morbidity and mortality in infected patients, are CPE [60].…”

“…1–4% in our review) were found [6]. ESBL-prevalence from universal admission screening was 8% in a study included in our review, which is comparable to the 10% prevalence found in a German study [9, 59]. One of the most urgent antibiotic resistant threats, coming along with increased morbidity and mortality in infected patients, are CPE [60].…”

Colonization with multi-drug-resistant organisms negatively impacts survival in patients with non-small cell lung cancer

“…Diabetes has previously been identified as a potential risk factor for MDRO colonization [36,37] and subsequent bloodstream infections with intestinal bacteria due to disruption of the gut barrier [38,39]. The overall prevalence of MDRO colonization at admission has been reported to be as high as 10% for ESBL producing Enterobacterales [40,41], reaching a prevalence of 20% in specific patient subgroups [9], and 2% for VRE [42] in German tertiary care centers. The colonization rate in our study was slightly lower than previously reported.…”

Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable?

“…Carriers of MRSA are known to have an increased risk of subsequent symtomatic infection (Van Belkum and Verbrugh 2001;Nelson et al 2018), whereas the risk of subsequent symtomatic infection in gut carriers of MDRGN is largely unkown (Turbett and Mansour 2016;Rottier et al 2015;Goulenok et al 2013;Boldt et al 2018). Recent reports indicate a very low frequency of subsequent symtomatic infection in a large unselected patient group of gut carriers (Lindblom et al 2018;Boldt et al 2018). 10 This is particularly salient since identification of an MDR carrier status increases the risk of broad-spectrum antibiotic overuse, which may have negative consequences for both individual and society.…”