Quantifying Hospital-Acquired Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Patients in Dutch Hospitals

Bergh, Marjolein Kluytmans-van den; Mens, Suzan P. van; Haverkate, Manon; Bootsma, Martin; Kluytmans, Jan; Bonten, Marc J. M.

doi:10.1017/ice.2017.241

Cited by 17 publications

(16 citation statements)

References 29 publications

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“…Newly identi ed carriers were most often colonized with ESBL-producing and/or Enterobacterales strains resistant to both an aminoglycoside and cipro oxacin (70%), MDRO of which the value of screening upon admission for the prevention of transmission and hospital-acquired infections is not well-established (25)(26)(27). In our study, the prevalence of newly detected ESBL carriage upon admission was 0.03% (95% CI: 0.02-0.04), which is considerably lower than the prevalence of faecal ESBL carriage in the Dutch community; which was 5% in randomly selected subjects (19) and 6.4-7.0% upon admission to our hospital (16). As a result, in our hospital, the proportion of ESBL carriers that still remained undetected upon admission despite risk-based screening was probably more than 99%.…”

Section: Discussioncontrasting

confidence: 58%

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant microorganisms (MDRO) in a Dutch tertiary care centre (2016 – 2019)

Hout

Bruijning-Verhagen

Blok

et al. 2020

Preprint

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Background In Dutch hospitals a 6-point questionnaire is mandatory for risk-assessment to identify carriers of multidrug-resistant organisms (MDRO) at the time of hospitalization. Presence of one or more risk factors is followed by microbiological culturing and pre-emptive isolation. We evaluated the test characteristics of this screening tool in identifying new MDRO carriers. MethodsA cross-sectional study using routinely collected healthcare data was performed in a Dutch tertiary hospital between 1 January 2015 and 1 August 2019 including all admissions with an MDRO risk assessment performed on the day of admission. MDRO risk-assessment included: (1) known MDRO carriage, (2) previous hospitalization in another Dutch hospital during a known outbreak, (3) previous hospitalization in a foreign hospital, (4) living in an asylum centre, (5) professional exposure to livestock farming and (6) household membership of a methicillin-resistant Staphylococcus aureus (MRSA) carrier. Sensitivity of the risk assessment was estimated by comparing observed prevalence of newly detected MDRO carriage to expected prevalence of carriage in the Dutch population upon hospital admission. Results 144,051 hospital admissions of 84,485 unique patients were included. In total, 4,480 (3.1%) admissions had a positive MDRO risk-assessment (i.e. ≥1 risk factors present). In 1,516 (34%) admissions microbiological screening was performed, of which 341 (23%) yielded MDRO. 81 patients were categorized as new MDRO carriers, as identified through MDRO risk-assessment, reflecting 0.06% (95% CI: 0.04%–0.07%) of all admissions and 1.8% (95% CI: 1.4%–2.2%) of those with positive risk assessment. MDRO included ESBL-producing and/or multidrug-resistant Enterobacterales (n=52, 64%), MRSA (n=26, 32%), carbapenem-resistant Enterobacterales (CRE) (n=2, 3%) and VRE (n=1, 1%). The numbers of “MDRO risk-assessments needed to perform” and individual “MDRO risk-assessment questions needed to ask” to detect one new MDRO carrier upon admission were 1,778 and 10,420, respectively. Estimated sensitivities of the risk-assessment for detecting MDRO carriage were <1%, for ESBL-E and VRE, <2% for CRE and 18% for MRSA. Conclusions The number of risk-assessments needed to perform to detect one new MDRO carrier upon hospital admission was high, and the vast majority of carriers most likely remained undetected. The current MDRO risk assessment upon admission strategy needs thorough reconsideration.

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Section: Discussioncontrasting

confidence: 58%

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant microorganisms (MDRO) in a Dutch tertiary care centre (2016 – 2019)

Hout

Bruijning-Verhagen

Blok

et al. 2020

Preprint

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“…Day care centers and long-term-care facilities are environments where human promiscuity might facilitate the CTX-M-27-and CTX-M-15-producing isolate transmission, respectively. The second risk factor found in our study, "hospitalization since birth," refers to hospital, another environment where multidrug-resistant bacteria are easily transmitted between patients due to health care (29). CTX-M-27-producing ST131 isolates are well-known for their transmission and colonization capacity in rehabilitation wards in Israel, illustrating their diffusion capacity (30).…”

Section: Discussionmentioning

confidence: 72%

Independent Host Factors and Bacterial Genetic Determinants of the Emergence and Dominance of Escherichia coli Sequence Type 131 CTX-M-27 in a Community Pediatric Cohort Study

Birgy

Lévy

Nicolas–Chanoine

et al. 2019

Antimicrob Agents Chemother

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The recent emergence and diffusion in the community of Escherichia coli isolates belonging to the multidrug-resistant and CTX-M-27-producing sequence type 131 (ST131) C1-M27 cluster makes this cluster potentially as epidemic as the worldwide E. coli ST131 subclade C2 composed of multidrug-resistant isolates producing CTX-M-15. Thirty-five extended-spectrum beta-lactamase (ESBL)-producing ST131 isolates were identified in a cohort of 1,885 French children over a 5-year period. They were sequenced to characterize the ST131 E. coli isolates producing CTX-M-27 recently emerging in France. ST131 isolates producing CTX-M-27 (n = 17), and particularly those belonging to the C1-M27 cluster (n = 14), carried many resistance-encoding genes and predominantly an F1:A2:B20 plasmid type. In multivariate analysis, having been hospitalized since birth (odds ratio [OR], 10.9; 95% confidence interval [CI], 2.4 to 48.8; P = 0.002) and being cared for in a day care center (OR, 9.4; 95% CI, 1.5 to 59.0; P = 0.017) were independent risk factors for ST131 CTX-M-27 fecal carriage compared with ESBL-producing non-ST131 isolates. No independent risk factor was found when comparing CTX-M-15 (n = 11)- and CTX-M-1/14 (n = 7)-producing ST131 isolates with ESBL-producing non-ST131 isolates or with non-ESBL-producing isolates. Several factors may contribute to the increase in fecal carriage of CTX-M-27-producing E. coli isolates, namely, resistance to multiple antibiotics, capacity of the CTX-M-27 enzyme to hydrolyze both cefotaxime and ceftazidime, carriage of a peculiar F-type plasmid, and/or capacity to colonize children who have been hospitalized since birth or who attend day care centers.

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“…Moreover, ESBLs are usually encoded on plasmids, which can be transferred independently from the bacterial clone even to other bacterial species. However, recent investigations have shown, that clonal spread of ESBL- E. coli in healthcare settings is rarely observed [ 8 , 9 ]. A second reason for divergent classifications was that the Dutch guideline uses combined fluoroquinolone and aminoglycoside resistance as a criterion for multidrug resistance.…”

Section: Discussionmentioning

confidence: 99%

Defining Multidrug Resistance of Gram-Negative Bacteria in the Dutch–German Border Region—Impact of National Guidelines

Köck

Siemer²,

Esser³

et al. 2018

Microorganisms

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Preventing the spread of multidrug-resistant Gram-negative bacteria (MDRGNB) is a public health priority. However, the definition of MDRGNB applied for planning infection prevention measures such as barrier precautions differs depending on national guidelines. This is particularly relevant in the Dutch–German border region, where patients are transferred between healthcare facilities located in the two different countries, because clinicians and infection control personnel must understand antibiograms indicating MDRGNB from both sides of the border and using both national guidelines. This retrospective study aimed to compare antibiograms of Gram-negative bacteria and classify them using the Dutch and German national standards for MDRGNB definition. A total of 31,787 antibiograms from six Dutch and four German hospitals were classified. Overall, 73.7% were no MDRGNB according to both guidelines. According to the Dutch and German guideline, 7772/31,787 (24.5%) and 4586/31,787 (12.9%) were MDRGNB, respectively (p < 0.0001). Major divergent classifications were observed for extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae, non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. The observed differences show that medical staff must carefully check previous diagnostic findings when patients are transferred across the Dutch–German border, as it cannot be assumed that MDRGNB requiring special hygiene precautions are marked in the transferred antibiograms in accordance with both national guidelines.

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Quantifying Hospital-Acquired Carriage of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Among Patients in Dutch Hospitals

Cited by 17 publications

References 29 publications

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant microorganisms (MDRO) in a Dutch tertiary care centre (2016 – 2019)

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant microorganisms (MDRO) in a Dutch tertiary care centre (2016 – 2019)

Independent Host Factors and Bacterial Genetic Determinants of the Emergence and Dominance of Escherichia coli Sequence Type 131 CTX-M-27 in a Community Pediatric Cohort Study

Defining Multidrug Resistance of Gram-Negative Bacteria in the Dutch–German Border Region—Impact of National Guidelines

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