Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis
Background The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active s...
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| Format: | Article |
| Language: | English |
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Korean Society of Critical Care Medicine
2016-11-01
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| Series: | Korean Journal of Critical Care Medicine |
| Subjects: | |
| Online Access: | http://kjccm.org/upload/pdf/kjccm-2016-00703.pdf |
| _version_ | 1818134514280431616 |
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| author | Yasumasa Kawano Takeshi Nishida Atsushi Togawa Yuhei Irie Kota Hoshino Norihiko Matsumoto Hiroyasu Ishikura |
| author_facet | Yasumasa Kawano Takeshi Nishida Atsushi Togawa Yuhei Irie Kota Hoshino Norihiko Matsumoto Hiroyasu Ishikura |
| author_sort | Yasumasa Kawano |
| collection | DOAJ |
| description | Background The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. Methods We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. Results We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/ piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). Conclusions Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation. |
| first_indexed | 2024-12-11T09:09:50Z |
| format | Article |
| id | doaj.art-24d3abbda3314280a05ad628a9dc6147 |
| institution | Directory Open Access Journal |
| issn | 2383-4870 2383-4889 |
| language | English |
| last_indexed | 2024-12-11T09:09:50Z |
| publishDate | 2016-11-01 |
| publisher | Korean Society of Critical Care Medicine |
| record_format | Article |
| series | Korean Journal of Critical Care Medicine |
| spelling | doaj.art-24d3abbda3314280a05ad628a9dc61472022-12-22T01:13:32ZengKorean Society of Critical Care MedicineKorean Journal of Critical Care Medicine2383-48702383-48892016-11-0131431732310.4266/kjccm.2016.007031057Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective AnalysisYasumasa Kawano0Takeshi Nishida1Atsushi Togawa2Yuhei Irie3Kota Hoshino4Norihiko Matsumoto5Hiroyasu Ishikura6 Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Medicine, Fukuoka University Hospital, Fukuoka, Japan Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, JapanBackground The effectiveness of surveillance to identify extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriers is controversial during a non-outbreak situation. We performed additional stool cultures for ESBL-E among intensive care unit (ICU) patients already under active surveillance by means of sputum and urine cultures. We aimed to assess the efficacy of stool cultures for screening for ESBL-E in a non-outbreak situation. Methods We conducted a retrospective cohort study in an ICU. Sputum and urine samples were cultured for ESBL-E surveillance purposes from January to September 2013 (phase 1). Stool cultures were routinely performed in addition from January to September 2014 (phase 2). Antimicrobial use density values and clinical outcomes were investigated and compared between phase 1 and 2. Results We identified 512 and 478 patients in phase 1 and phase 2, respectively. ESBL-E were found in the feces of 65 (13.6%) patients in phase 2. The antimicrobial use density values (expressed as defined daily doses per 1,000 bed-days) were not significantly different between the two phases for fluoroquinolones (7 vs. 10, p = 0.376), third-generation cephalosporins (24.2 vs. 29.5, p = 0.724), tazobactam/ piperacillin (44.6 vs. 57.3, p = 0.489), and carbapenems (73 vs. 55.5, p = 0.222). Moreover, there were no significant differences in ICU mortality and length of stay (11.5% vs. 9.8%, p = 0.412, and 9 vs. 10 days, p = 0.28, respectively). Conclusions Stool culture seemed ineffective in improving the antimicrobial use density of broad-spectrum antimicrobials, clinical outcomes, and ICU length of stay, and is not recommended for surveillance of ESBL-E in a non-outbreak situation.http://kjccm.org/upload/pdf/kjccm-2016-00703.pdfbeta-lactamasesenterobacteriaceaeepidemiologyoutbreaks |
| spellingShingle | Yasumasa Kawano Takeshi Nishida Atsushi Togawa Yuhei Irie Kota Hoshino Norihiko Matsumoto Hiroyasu Ishikura Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis Korean Journal of Critical Care Medicine beta-lactamases enterobacteriaceae epidemiology outbreaks |
| title | Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis |
| title_full | Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis |
| title_fullStr | Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis |
| title_full_unstemmed | Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis |
| title_short | Surveillance of Extended-Spectrum β-Lactamase-producing Carriage in a Japanese Intensive Care Unit: a Retrospective Analysis |
| title_sort | surveillance of extended spectrum β lactamase producing carriage in a japanese intensive care unit a retrospective analysis |
| topic | beta-lactamases enterobacteriaceae epidemiology outbreaks |
| url | http://kjccm.org/upload/pdf/kjccm-2016-00703.pdf |
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