Extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage upon hospital admission: prevalence and risk factors

Shitrit, Pnina; Reisfeld, Sharon; Paitan, Yossi; Bs, Gottesman; Katzir, Miki; Chowers, Michal

doi:10.1016/j.jhin.2013.07.014

Cited by 26 publications

(22 citation statements)

References 6 publications

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“…In this study, prior ESBL carriage, hospital admission within the last 6 months, and male gender were associated with ESBL carriage, which confirms results from previous studies [9,14,15]. Although male gender has been identified as a risk factor for ESBL carriage in previous studies as well, the biologic substrate remains unknown [12].…”

Section: Discussionsupporting

confidence: 89%

“…Although male gender has been identified as a risk factor for ESBL carriage in previous studies as well, the biologic substrate remains unknown [12]. We could not confirm findings from two studies in Israel in which nursing home residence was a risk factor for ESBL carriage at the time of hospital admission [9,14]. Possibly, this is a result of the restrictive antibiotic policy in the Netherlands.…”

Section: Discussionmentioning

confidence: 59%

“…Increasing the positive predictive value toward clinically useful values would reduce the sensitivity to unacceptable low levels. Previous attempts in retrospective studies in single centres or single wards, and with fewer patients enrolled, also failed to develop such a prediction rule [10,14,18]. This is possibly the result of heterogeneous transmission routes that include nosocomial, household, and food contacts.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

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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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“…[38][39][40] Long term residents of aged care facilities, who have frequent exposure to healthcare and antibiotics and experience common cross-transmission of bacteria, also tend to have a high prevalence of antibiotic resistance. [41][42][43][44][45] Much of the available antibiotic resistance data are from clinical (typically, hospital) contexts, in which antibiotic exposure and cross-transmission are expected to be increased, especially in resource limited settings. However, prevalence varies between populations in a c arbapenems (such as meropenem and doripenem) and fluoroquinolones (such as ciprofloxacin and levofloxacin).…”

Section: Incidence and Prevalencementioning

confidence: 99%

Antibiotic resistance in Enterobacteriaceae: mechanisms and clinical implications

Iredell

Brown

Tagg

2016

BMJ

287

177

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Resistance of the Enterobacteriaceae to antibiotics, especially of the β lactam type, is increasingly dominated by the mobilization of continuously expressed single genes that encode efficient drug modifying enzymes. Strong and ubiquitous selection pressure has seemingly been accompanied by a shift from "natural" resistance, such as inducible chromosomal enzymes, membrane impermeability, and drug efflux, to the modern paradigm of mobile gene pools that largely determine the epidemiology of modern antibiotic resistance. In this way, antibiotic resistance is more available than ever before to organisms such as Escherichia coli and Klebsiella pneumoniae that are important causes of major sepsis. Modulation of the phenotype by host bacteria makes gene transmission less obvious and may in part explain why tracking and control of carbapenem resistance has been particularly problematic in the Enterobacteriaceae. This review discusses the underlying principles and clinical implications of the mobility and fixation of resistance genes and the exploitable opportunities and potential threats arising from apparent limitations on diversity in these mobile gene pools. It also provides some illustrative paradoxes and clinical corollaries, as well as a summary of future options.

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“…Studies of the prevalence of ESBL-PE in children have mainly focused on fecal carriage in the community, 9,17–19 and risk factors for community-onset infection caused by ESBL-PE (e.g., presence of comorbidities and recent hospitalization or antibiotic therapy, notably cephalosporins and fluoroquinolones) have been more studied in adults 1,20–37 than in children. 10,11,29,38–40 Most studies did not differentiate community- and healthcare-associated infections, the latter now considered almost identical to nosocomial infections.…”

Section: Introductionmentioning

confidence: 99%

Community-Onset Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France

et al. 2016

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Limited data is available on pediatric community-onset infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), but such infections may affect both the efficacy of empiric antibiotic therapy and the rational use of antibiotics.We retrospectively analyzed data from 2007 to 2012 for all children ≤16 years old with a positive ESBL-PE strain from usually sterile sites within 48 hours of admission in a tertiary hospital in France. We analyzed healthcare- and community-associated infections among community-onset infections. In total, 3612 Enterobacteriaceae isolates were collected; the prevalence of ESBL-PE infection increased over the study period, from 2.4% to 5.1% (P < 0.001). Among the 90 children with a first community-onset ESBL-PE infection, 58% (n = 52) had a healthcare-associated infection, and 87% of isolates were susceptible to amikacin. As compared with patients with community-associated infections, those with healthcare-associated infections had fewer urinary tract infections (UTIs) (86% vs 97%) and Escherichia coli infections (35% vs 84%) and more Klebsiella pneumoniae infections (46% vs 8%). Inappropriate empiric treatment was prescribed for 54 patients (64%), but a favorable outcome was observed in 46 of 49 (94%) and 1 of 5 (20%) patients with UTIs and non-UTIs, respectively (P < 0.001). Among patients with community-associated infections, 85% had at least 1 risk factor for ESBL-PE infections. In conclusion, the prevalence of community-onset ESBL-PE infections doubled during the study period. These infections mainly occurred among children with healthcare-associated criteria or identified risk factors. Amikacin is an alternative to carbapenems for empiric treatment because most of these infections involved urinary tract and susceptible isolates.

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Extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage upon hospital admission: prevalence and risk factors

Cited by 26 publications

References 6 publications

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

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

Antibiotic resistance in Enterobacteriaceae: mechanisms and clinical implications

Community-Onset Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae Invasive Infections in Children in a University Hospital in France

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