Prevalence of Antibiotic Resistance of the Commensal Flora in Dutch Nursing Homes

Hoogendoorn, Mirjam; Smalbrugge, Martin; Stobberingh, Ellen E.; Rossum, Saskia V. van; Vlaminckx, Bart J. M.; Thijsen, Steven

doi:10.1016/j.jamda.2012.11.001

Cited by 14 publications

(12 citation statements)

References 12 publications

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“…Other ESBL genes belonged to the CTX-M-9 group (n ϭ 3 [11.1%]), the SHV family (SHV 238S ϩ 240K) (n ϭ 3 [11.1%]), and the TEM family (TEM 104K ϩ 238S) (n ϭ 1 [3.7%]). The observed overall prevalence of ESBL-E rectal carriage of 4.8% and the distribution of ESBL genes are similar to those found in previous studies in Dutch health care settings (20,26).…”

supporting

confidence: 88%

Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Selective Preenrichment Increases Yield of Screening

et al. 2015

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dThis study evaluated the added value of selective preenrichment for the detection of rectal carriage of extended-spectrum-betalactamase-producing Enterobacteriaceae (ESBL-E). ESBL-E rectal carriage was identified in 4.8% of hospitalized patients, and 25.9% of ESBL-E rectal carriers were identified with selective preenrichment only. The steady worldwide spread of extended-spectrum-beta-lactamase-producing Enterobacteriaceae (ESBL-E) has affected health care and community settings, as well as livestock farming (1-4). Extended-spectrum beta-lactamase (ESBL) confers resistance to the majority of beta-lactam antibiotics, including thirdgeneration cephalosporins, which limits the options for antimicrobial therapy and results in increased morbidity and mortality rates and health care costs (5, 6). Appropriate antimicrobial therapy and infection control measures depend on rapid sensitive laboratory detection methods. Unfortunately, reliable standardized methods for direct molecular detection of ESBL-E in clinical specimens are currently not available for routine use in medical microbiology. Therefore, the targeted ESBL-E screening of clinical specimens relies on the use of selective screening agars for ESBL, several of which, with comparable high sensitivities, have been described (7-13). It has been shown that preenrichment using a broth improves the performance of selective screening agars for the detection of methicillin-resistant Staphylococcus aureus in clinical specimens (14-17). However, the use of preenrichment for the detection of ESBL-E is still controversial (18) and is not common practice in clinical or research settings. Although several studies on the occurrence of ESBL-E have used nonselective or selective preenrichment (19,20), comparative data that quantify the added value of preenrichment are limited. A comparative study showed that nonselective preenrichment improved the detection of ESBL-E in throat and rectal surveillance cultures from intensive care unit (ICU) patients (21). That study was performed in a setting in which all patients received selective decontamination of the digestive tract (SDD), and the use of a nonselective medium would hardly have been hampered by overgrowth with nonresistant flora. The detection of ESBL-E in fecal or rectal samples from patients who are not receiving antibiotics, however, is complicated by the presence of nonresistant gastrointestinal flora and would benefit from the use of selective culture media. At present, no comparative data on the use of preenrichment with a selective broth for the detection of ESBL-E rectal carriage are available. This study aimed to determine the added value of selective preenrichment for the detection of rectal carriage of ESBL-E in hospitalized patients.In October 2011, an ESBL-E prevalence survey was performed in an 850-bed Dutch teaching hospital, where yearly ESBL-E prevalence surveys are part of the routine infection control policy.Rectal swabs were taken from all patients who were hospitalized on the day of the survey and were ...

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confidence: 88%

Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Selective Preenrichment Increases Yield of Screening

et al. 2015

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“…Two studies on the carriage of antimicrobial-resistant commensal bacteria in Dutch LTCFs reported prevalences of 4.2% (n ¼ 4763 nasal swabs) and 6.0% (n ¼ 125 residents) ESBL-producing E coli. 33,34 MRSA prevalence was low in both studies: 0.3% (n ¼ 5359 urine/incontinence samples) and 0% (n ¼ 125 residents), respectively.…”

Section: Antibiotic Stewardshipmentioning

confidence: 74%

Antibiotic Stewardship in European Nursing Homes: Experiences From the Netherlands, Norway, Poland, and Sweden

Buul¹,

Monnier²,

Sundvall

et al. 2020

Journal of the American Medical Directors Association

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“…colonization [3]. Prevalence of ESBL carriage in hospitalized patients and patients treated in long-term-care facilities (LTCFs) have been reported to be as high as 27% [4,5], and the prevalence of ESBL-carriage in non-hospitalized subjects seems to be increasing (www.isisweb.nl) [6,7].…”

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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Prevalence of Antibiotic Resistance of the Commensal Flora in Dutch Nursing Homes

Cited by 14 publications

References 12 publications

Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Selective Preenrichment Increases Yield of Screening

Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Selective Preenrichment Increases Yield of Screening

Antibiotic Stewardship in European Nursing Homes: Experiences From the Netherlands, Norway, Poland, and Sweden

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

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