Michel Djibré1, Samuel Fedun2, Pierre Le Guen2, Sophie Vimont3, Mehdi Hafiani4, Jean-Pierre Fulgencio2, Antoine Parrot2, Michel Denis5, Muriel Fartoukh4. 1. Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: michel.djibre@tnn.aphp.fr. 2. Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France. 3. Service de Bactériologie-Hygiène, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Univ, Paris, France. 4. Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Univ, Paris, France. 5. Service de Maladies Infectieuses et Tropicales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
Abstract
BACKGROUND: Although additional contact precautions (ACPs) are routinely used to reduce cross-transmission of multidrug-resistant organisms (MDROs), the relevance of isolation precautions remains debated. We hypothesized that the collection of recognized risk factors for MDRO carriage on intensive care unit (ICU) admission might be helpful to target ACPs without increasing MDRO acquisition during ICU stays, compared with universal ACPs. MATERIALS AND METHODS: This is a sequential single-center observational study performed in consecutive patients admitted to a French medical and surgical ICU. During the first 6-month period, screening for MDRO carriage and ACPs were performed in all patients. During the second 6-month period, screening was maintained, but ACP use was guided by the presence of at least 1 defined risk factor for MDRO. RESULTS: During both periods, 33 (10%) and 30 (10%) among 327 and 297 admissions were, respectively, associated with a positive admission MDRO carriage. During both periods, a second screening was performed in 147 (45%) and 127 (43%) patients. Altogether, the rate of acquired MDRO (positive screening or clinical specimen) was similar during both periods (10% [n = 15] and 11.8% [n = 15], respectively; P = .66). CONCLUSIONS: The results of our study contribute to support the safety of an isolation-targeted screening policy on ICU admission compared with universal screening and isolation regarding the rate of ICU-acquired MDRO colonization or infection.
BACKGROUND: Although additional contact precautions (ACPs) are routinely used to reduce cross-transmission of multidrug-resistant organisms (MDROs), the relevance of isolation precautions remains debated. We hypothesized that the collection of recognized risk factors for MDRO carriage on intensive care unit (ICU) admission might be helpful to target ACPs without increasing MDRO acquisition during ICU stays, compared with universal ACPs. MATERIALS AND METHODS: This is a sequential single-center observational study performed in consecutive patients admitted to a French medical and surgical ICU. During the first 6-month period, screening for MDRO carriage and ACPs were performed in all patients. During the second 6-month period, screening was maintained, but ACP use was guided by the presence of at least 1 defined risk factor for MDRO. RESULTS: During both periods, 33 (10%) and 30 (10%) among 327 and 297 admissions were, respectively, associated with a positive admission MDRO carriage. During both periods, a second screening was performed in 147 (45%) and 127 (43%) patients. Altogether, the rate of acquired MDRO (positive screening or clinical specimen) was similar during both periods (10% [n = 15] and 11.8% [n = 15], respectively; P = .66). CONCLUSIONS: The results of our study contribute to support the safety of an isolation-targeted screening policy on ICU admission compared with universal screening and isolation regarding the rate of ICU-acquired MDRO colonization or infection.