BACKGROUND: The duration of gastrointestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) may play a major role in the spread of these organisms. We evaluated the time to, and factors associated with, ESBL-E clearance after hospital discharge. METHODS: We retrospectively reviewed prospective surveillance results obtained over 14 years in a 1,000-bed hospital. The surveillance collected demographic, hospital stay, microbiologic, and outcome data. An automatic alert system identified readmitted patients with prior ESBL-E carriage. ESBL-E clearance was defined as a negative rectal screening sample at readmission with no new positive clinical sample during the stay. Variables associated with ESBL-E clearance were identified using a Cox model. RESULTS: We included 1,884 patients with 2,734 admissions. Four hundred forty-eight patients with readmission screening formed the basis for the study. Of 448 patients with 1 to 16 readmissions, 180 (40%) were persistent carriers. The median time to ESBL-E clearance was 6.6 months. Variables independently associated with clearance was having the first positive culture in a screening sample only (adjusted hazard ratio, 1.31; 95% confidence interval, 1.02-1.69; P = .04) and period 2005-2010 (hazard ratio, 1.88; 95% confidence interval, 1.33-2.67; P < .01). CONCLUSION: We found a long duration of ESBL-E carriage after hospital discharge. An automatic alert system was useful for identifying, screening, and isolating previous ESBL-E carriers.
BACKGROUND: The duration of gastrointestinal colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) may play a major role in the spread of these organisms. We evaluated the time to, and factors associated with, ESBL-E clearance after hospital discharge. METHODS: We retrospectively reviewed prospective surveillance results obtained over 14 years in a 1,000-bed hospital. The surveillance collected demographic, hospital stay, microbiologic, and outcome data. An automatic alert system identified readmitted patients with prior ESBL-E carriage. ESBL-E clearance was defined as a negative rectal screening sample at readmission with no new positive clinical sample during the stay. Variables associated with ESBL-E clearance were identified using a Cox model. RESULTS: We included 1,884 patients with 2,734 admissions. Four hundred forty-eight patients with readmission screening formed the basis for the study. Of 448 patients with 1 to 16 readmissions, 180 (40%) were persistent carriers. The median time to ESBL-E clearance was 6.6 months. Variables independently associated with clearance was having the first positive culture in a screening sample only (adjusted hazard ratio, 1.31; 95% confidence interval, 1.02-1.69; P = .04) and period 2005-2010 (hazard ratio, 1.88; 95% confidence interval, 1.33-2.67; P < .01). CONCLUSION: We found a long duration of ESBL-E carriage after hospital discharge. An automatic alert system was useful for identifying, screening, and isolating previous ESBL-E carriers.
Authors: Nenad Macesic; Angela Gomez-Simmonds; Sean B Sullivan; Marla J Giddins; Samantha A Ferguson; Gautam Korakavi; David Leeds; Sarah Park; Kevin Shim; Madeleine G Sowash; Melanie Hofbauer; Ryan Finkel; Yue Hu; Jared West; Nora C Toussaint; William G Greendyke; Benjamin A Miko; Marcus R Pereira; Susan Whittier; Elizabeth C Verna; Anne-Catrin Uhlemann Journal: Clin Infect Dis Date: 2018-08-31 Impact factor: 9.079
Authors: M Hong Nguyen; Ryan K Shields; Liang Chen; A William Pasculle; Binghua Hao; Shaoji Cheng; Jonathan Sun; Ellen G Kline; Barry N Kreiswirth; Cornelius J Clancy Journal: Clin Infect Dis Date: 2022-02-11 Impact factor: 9.079
Authors: W Dohmen; L VAN Gompel; H Schmitt; A Liakopoulos; L Heres; B A Urlings; D Mevius; M J M Bonten; D J J Heederik Journal: Epidemiol Infect Date: 2017-05-02 Impact factor: 4.434
Authors: Rasmus Leistner; Elisabeth Meyer; Petra Gastmeier; Yvonne Pfeifer; Christoph Eller; Petra Dem; Frank Schwab Journal: PLoS One Date: 2013-09-11 Impact factor: 3.240