Aurélien Emmanuel Martinez1, Andreas Widmer1, Reno Frei1, Hans Pargger2, Daniel Tuchscherer2, Stephan Marsch3, Adrian Egli4, Sarah Tschudin-Sutter1. 1. Division of Infectious Diseases and Hospital Epidemiology,University Hospital Basel,Basel,Switzerland. 2. Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management,University Hospital Basel,Basel,Switzerland. 3. Department of Intensive Care Medicine,University Hospital of Basel,Basel,Switzerland. 4. Clinical Microbiology,University Hospital Basel,Basel,Switzerland.
Abstract
OBJECTIVE: To determine whether colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients. DESIGN: Prospective cohort study. SETTING: The 2 ICUs in the University Hospital Basel in Switzerland. PATIENTS: All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours. METHODS: Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test. RESULTS: Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40-271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01-5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3-8 days] vs median, 6 days [IQR 3-9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44-2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28-5.11; P = .808). CONCLUSIONS: Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.
OBJECTIVE: To determine whether colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients. DESIGN: Prospective cohort study. SETTING: The 2 ICUs in the University Hospital Basel in Switzerland. PATIENTS: All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours. METHODS:Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test. RESULTS: Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40-271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01-5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3-8 days] vs median, 6 days [IQR 3-9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44-2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28-5.11; P = .808). CONCLUSIONS: Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.
Authors: Dory Kovacs; Vitus Silago; Delfina R Msanga; Stephen E Mshana; Jeremiah Seni; Katarina Oravcova; Louise Matthews Journal: Sci Rep Date: 2022-05-19 Impact factor: 4.996