Clinical profiles of patients colonized or infected with extended-spectrum beta-lactamase producing Enterobacteriaceae isolates: a 20 month retrospective study at a Belgian University Hospital

Stilmant, Didier; Bogaerts, Pierre; Grimmelprez, Alexandre; Saint-Hubert, Marie de; Delaere, Bénédicte; Jamart, Jacques; Swine, Christian; Glupczynski, Youri

doi:10.1186/1471-2334-11-12

Cited by 31 publications

(32 citation statements)

References 36 publications

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“…In an earlier study, we hypothesized that healthy adults and individuals applying for long‐term care, including those with an extensive hospitalization history, may differ regarding sources of colonization with ESBL producers . It is conceivable that of hospitalized patients are colonized from the hospital microbiota , whereas we postulated that ESBL producers in healthy individuals originate in part from diverse environmental sources .…”

Section: Discussionmentioning

confidence: 98%

Comparison of rates of fecal colonization with extended‐spectrum beta‐lactamase‐producing enterobacteria among patients in different wards, outpatients and medical students

Ebrahimi

Mózes

Monostori

et al. 2016

Microbiology and Immunology

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Because asymptomatic carriage of extended-spectrum beta-lactamase (ESBL) producers is a risk factor for infection, data on colonization dynamics are important when planning infection control. This study investigated fecal colonization with ESBL producers among inpatients, outpatients and medical students and compares the characteristics of ESBL producers among these groups. Carriage rates were investigated in 5581 fecal samples; 4343 from inpatients (330, 1397, 619 and 1864 from adult ICUs [intensive care units], adult non-ICUs, pediatric ICUs and pediatric non-ICUs, respectively), 814 from outpatients and 424 from screening of medical students. ESBL producers were characterized by co-resistance, integrons carried, and aminoglycoside resistance and ESBL genes. Dynamic regression models were built to identify relationships between combinations of time series of monthly antibiotic consumption, prevalence of carriers and infected subjects. Inpatients, ICU patients and adults showed higher prevalence than outpatients, non-ICU patients or children (7.4%, 9.3% and 12.0% vs. 3.1%, 6.1% and 4.1%, respectively). Klebsiella pneumoniae was more frequent in ICU patients; dominance of CTX-M-15 producers was more marked in adult than in pediatric inpatients. ESBL carriage was shown to be a consequence of infection in adults in the time-series analysis; antibiotic consumption had little effect. The epidemiology of colonization with ESBL producers differed between pediatric ICU, adult ICU and adult non-ICU patients. In adults, carriage of ESBL producers seems to be the consequence of infection, especially in ICU patients; the main source of colonization is nosocomial acquisition. In contrast, children are less likely to acquire colonizer strains in hospitals; importation of ESBL producers by colonized children seems to be significant.

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Section: Discussionmentioning

confidence: 98%

Comparison of rates of fecal colonization with extended‐spectrum beta‐lactamase‐producing enterobacteria among patients in different wards, outpatients and medical students

Ebrahimi

Mózes

Monostori

et al. 2016

Microbiology and Immunology

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“…Indeed, most previous studies were retrospective or cohort studies [9], [16], [20], [24]–[27]. In addition, previous case-control studies compared mostly cases to a single control group comprising patients with a clinical sample positive for a non-ESBL-producing micro-organism [17], [21], [28].…”

Section: Discussionmentioning

confidence: 99%

Patient's Origin and Lifestyle Associated with CTX-M-Producing Escherichia coli: A Case-Control-Control Study

et al. 2012

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BackgroundGlobal dissemination of Escherichia coli producing CTX-M extended-spectrum β-lactamases (ESBL) is a public health concern. The aim of the study was to determine factors associated with CTX-M- producing E. coli infections among patients hospitalised in the Assistance Publique-Hôpitaux de Paris, the largest hospital system in France (23 000 beds), through a prospective case-control-control study.Methods/Principal FindingsFrom November 2008 to June 2009, 152 inpatients with a clinical sample positive for CTX-M-producing E. coli (cases), 152 inpatients with a clinical sample positive for non ESBL-producing E. coli on the day or within the three days following case detection (controls C1), and 152 inpatients with culture-negative clinical samples since the beginning of hospitalisation and until three days after case detection (controls C2) were included in ten hospitals of the Paris area. Factors studied were related to patient's origin, lifestyle and medical history as well as care during hospitalisation. Those independently associated with CTX-M-producing E. coli were determined. Three independent factors were common to the two case-control comparisons: birth outside of Europe (cases vs C1: OR1 = 2.4; 95%CI = [1.3–4.5] and cases vs C2: OR2 = 3.1; 95%CI = [1.4–7.0]), chronic infections (OR1 = 2.9; 95%CI = [1.3–6.9] and OR2 = 8.7; 95%CI = [2.0–39.7]), and antibiotic treatment between hospital admission and inclusion (OR1 = 2.0; 95%CI = [1.0–3.8] and OR2 = 3.3; 95%CI = [1.5–7.2]). Cases were also more likely to be (i) functionally dependent before hospitalisation than C2 (OR2 = 7.0; 95%CI = [2.1–23.5]) and (ii) living in collective housing before hospitalisation than C2 (OR2 = 15.2; 95%CI = [1.8–130.7]) when CTX-M-producing E. coli was present at admission.ConclusionFor the first time, patient's origin and lifestyle were demonstrated to be independently associated with isolation of CTX-M-producing E. coli, in addition to health care-related factors.

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“…Previous hospital stay, severity of illness, time in the intensive care unit (ICU), intubation and mechanical ventilation, urinary or arterial catheterisation, previous exposure to antibiotics, and urinary tract infections have been identified as risk factors for acquisition of ESBL-producing bacteria during hospital stay [8][9][10][11]. In addition, LTCF residents are considered to have an increased risk of ESBL carriage due to the presumed high risk for acquisition and transmission of ESBL-producing bacteria in these settings, facilitated by antibiotic use, understaffing, and failing infection control measures [12].…”

Section: Introductionmentioning

confidence: 99%

Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study

Platteel

Hall

Stuart

et al. 2015

Clinical Microbiology and Infection

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The prevalence of patients colonized with extended-spectrum beta-lactamase (ESBL)-producing bacteria increases, especially in long-term-care facilities (LTCFs). Identification of ESBL carriers at hospital admission is relevant for infection control measures and antibiotic therapy for nosocomial infections. We aimed to develop a prediction rule for ESBL carriage at hospital admission for patients admitted from home and LTCFs, and to quantify incidences of nosocomial infections caused by ESBL-producing bacteria. The ESBL-carrier status was determined of patients admitted from LTCFs and from home settings in four hospitals in the Netherlands using perianal swabs obtained within 48 hours of admission. Risk factors for ESBL carriage were assessed. Infections caused by ESBL-producing bacteria were identified retrospectively. Among 1351 patients, 111 (8.2%) were ESBL carriers at admission: 50/579 (8.6%) admitted from LTCFs and 61/772 (7.9%) from home settings (p 0.63). Previous ESBL carriage and previous hospital admission were risk factors for ESBL carriage in multivariable analysis. The area under the curve of the receiver operating characteristic curve of the model was 0.64 (95% CI 0.58-0.71). Presence of ≥1 risk factor (n = 803; 59%) had sensitivity of 72%. Incidences of nosocomial infections caused by ESBL-producing bacteria were 45.5/10,000 and 2.1/10,000 admission days for ESBL carriers and non-carriers, respectively (p <0.05). In conclusion, prevalence of ESBL carriage at hospital admission was 8.2%, and was comparable among patients admitted from LTCF and home. A clinically useful prediction rule for ESBL carriage at admission could not be developed. The absolute incidence of nosocomial infections by ESBL-producing bacteria was low, but higher among patients carrying ESBL-producing bacteria at the time of hospital admission.

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Clinical profiles of patients colonized or infected with extended-spectrum beta-lactamase producing Enterobacteriaceae isolates: a 20 month retrospective study at a Belgian University Hospital

Cited by 31 publications

References 36 publications

Comparison of rates of fecal colonization with extended‐spectrum beta‐lactamase‐producing enterobacteria among patients in different wards, outpatients and medical students

Comparison of rates of fecal colonization with extended‐spectrum beta‐lactamase‐producing enterobacteria among patients in different wards, outpatients and medical students

Patient's Origin and Lifestyle Associated with CTX-M-Producing Escherichia coli: A Case-Control-Control Study

Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study

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