OBJECTIVE: To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU). DESIGN: Prospective survey of 2235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). SETTING: A surgical ICU in a tertiary-care teaching hospital. PATIENTS: All admitted patients. INTERVENTIONS: Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers. RESULTS: The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBLE decreased from 5.5 cases per 1000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage. CONCLUSIONS: MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.
OBJECTIVE: To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU). DESIGN: Prospective survey of 2235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). SETTING: A surgical ICU in a tertiary-care teaching hospital. PATIENTS: All admitted patients. INTERVENTIONS: Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers. RESULTS: The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBLE decreased from 5.5 cases per 1000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage. CONCLUSIONS: MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.
Authors: Marcie Tomblyn; Tom Chiller; Hermann Einsele; Ronald Gress; Kent Sepkowitz; Jan Storek; John R Wingard; Jo-Anne H Young; Michael J Boeckh; Michael A Boeckh Journal: Biol Blood Marrow Transplant Date: 2009-10 Impact factor: 5.742
Authors: Jessica P Ridgway; Lance R Peterson; Richard B Thomson; Becky A Miller; Marc-Oliver Wright; Donna M Schora; Ari Robicsek Journal: J Clin Microbiol Date: 2014-08-20 Impact factor: 5.948
Authors: Doris Schacherer; Frank Klebl; Daniela Goetz; Roland Buettner; Stephanie Zierhut; Juergen Schoelmerich; Julia Langgartner Journal: Intensive Care Med Date: 2007-03-16 Impact factor: 17.440