E Dyakova1, K N Bisnauthsing2, A Querol-Rubiera2, A Patel2, C Ahanonu2, O Tosas Auguet2, J D Edgeworth2, S D Goldenberg2, J A Otter3. 1. Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London & Guy's and St. Thomas' NHS Foundation Trust, London, UK; Imperial College London Health Protection Research Unit (HPRU) in HCAI and AMR, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, UK. 2. Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London & Guy's and St. Thomas' NHS Foundation Trust, London, UK. 3. Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London & Guy's and St. Thomas' NHS Foundation Trust, London, UK; Imperial College London Health Protection Research Unit (HPRU) in HCAI and AMR, and Imperial College Healthcare NHS Trust, Infection Prevention and Control, London, UK. Electronic address: j.otter@imperial.ac.uk.
Abstract
OBJECTIVES: We evaluated 'pre-laboratory' factors associated with the detection of extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonization including anatomical site, and staff and patient factors. METHODS: All admissions to a large London hospital over 3 months were approached to provide rectal and perineal swabs, which were cultured for ESBL-E using chromogenic media. ESBL-E detection rates for patient- or staff-collected rectal or perineal swabs were compared using McNemar tests. Binary logistic regression was used to explore factors associated with patients declining to provide a rectal swab. The impact of simplifying the verbal study description to patients to improve the participation rate was evaluated. RESULTS: Carriage of ESBL-E was significantly higher in rectal swabs than perineal swabs (7.8% of 4006 versus 3.8% of 4006, p <0.001), whether collected by staff or patients; 31.9% of 869 patients did not provide a rectal swab before the change in study description compared with 7.6% of 3690 patients afterwards (p <0.001). In multivariable analysis, factors associated with patients declining to provide a rectal swab were younger age (OR 0.99, 95% CI 0.99-1.00), female gender (OR 1.26, 95% CI 1.04-1.52), transfers from other hospitals (OR 1.77, 95% CI 1.07-2.93) or an unknown admission route (OR 1.61, 95% CI 1.09-2.37), being admitted before the change in study description (OR 0.39, 95% CI 0.31-0.48), and the staff member who consented the patient (p <0.001); ethnicity was not a significant factor. CONCLUSIONS: Rectal swabs are recommended for the detection of ESBL-E colonization. Staff and patient factors influence whether patients participate in prevalence studies, which may skew their findings.
OBJECTIVES: We evaluated 'pre-laboratory' factors associated with the detection of extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) colonization including anatomical site, and staff and patient factors. METHODS: All admissions to a large London hospital over 3 months were approached to provide rectal and perineal swabs, which were cultured for ESBL-E using chromogenic media. ESBL-E detection rates for patient- or staff-collected rectal or perineal swabs were compared using McNemar tests. Binary logistic regression was used to explore factors associated with patients declining to provide a rectal swab. The impact of simplifying the verbal study description to patients to improve the participation rate was evaluated. RESULTS: Carriage of ESBL-E was significantly higher in rectal swabs than perineal swabs (7.8% of 4006 versus 3.8% of 4006, p <0.001), whether collected by staff or patients; 31.9% of 869 patients did not provide a rectal swab before the change in study description compared with 7.6% of 3690 patients afterwards (p <0.001). In multivariable analysis, factors associated with patients declining to provide a rectal swab were younger age (OR 0.99, 95% CI 0.99-1.00), female gender (OR 1.26, 95% CI 1.04-1.52), transfers from other hospitals (OR 1.77, 95% CI 1.07-2.93) or an unknown admission route (OR 1.61, 95% CI 1.09-2.37), being admitted before the change in study description (OR 0.39, 95% CI 0.31-0.48), and the staff member who consented the patient (p <0.001); ethnicity was not a significant factor. CONCLUSIONS: Rectal swabs are recommended for the detection of ESBL-E colonization. Staff and patient factors influence whether patients participate in prevalence studies, which may skew their findings.
Authors: Matteo Balzarro; Emanuele Rubilotta; Nicolò Trabacchin; Antonio Soldano; Clara Cerrato; Filippo Migliorini; Vito Mancini; Antonio Luigi Pastore; Antonio Carbone; Luigi Cormio; Giuseppe Carrieri; Alessandro Antonelli Journal: J Clin Med Date: 2020-06-11 Impact factor: 4.241