Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae.
OBJECTIVE: We hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates. DESIGN: Retrospective cohort study. SETTING: 12 hospitals (6 screening and 6 non-screening) in Toronto, Can...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2013-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3637447?pdf=render |
| _version_ | 1811266560671612928 |
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| author | Christopher F Lowe Kevin Katz Allison J McGeer Matthew P Muller Toronto ESBL Working Group |
| author_facet | Christopher F Lowe Kevin Katz Allison J McGeer Matthew P Muller Toronto ESBL Working Group |
| author_sort | Christopher F Lowe |
| collection | DOAJ |
| description | OBJECTIVE: We hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates. DESIGN: Retrospective cohort study. SETTING: 12 hospitals (6 screening and 6 non-screening) in Toronto, Canada. PATIENTS: All adult inpatients with an ESBL-E positive culture collected from 2005-2009. METHODS: Cases were defined as hospital-onset (HO) or community-onset (CO) if cultures were positive after or before 72 hours. Efficacy of screening in reducing HO-ESBL-E incidence was assessed with a negative binomial model adjusting for study year and CO-ESBL-E incidence. The accuracy of the HO-ESBL-E definition was assessed by re-classifying HO-ESBL-E cases as confirmed nosocomial (negative admission screen), probable nosocomial (no admission screen) or not nosocomial (positive admission screen) using data from the screening hospitals. RESULTS: There were 2,088 ESBL-E positive patients and incidence of ESBL-E rose from 0.11 to 0.42 per 1,000 inpatient days between 2005 and 2009. CO-ESBL-E incidence was similar at screening and non-screening hospitals but screening hospitals had a lower incidence of HO-ESBL-E in all years. In the negative binomial model, screening was associated with a 49.1% reduction in HO-ESBL-E (p<0.001). A similar reduction was seen in the incidence of HO-ESBL-E bacteremia. When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases. CONCLUSIONS: Admission screening for ESBL-E is associated with a reduced incidence of HO-ESBL-E. Controlled, prospective studies of admission screening for ESBL-E should be a priority. |
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| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-04-12T20:44:20Z |
| publishDate | 2013-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-f9c08c15eb804eb7af1154b36150bc8e2022-12-22T03:17:19ZengPublic Library of Science (PLoS)PLoS ONE1932-62032013-01-0184e6267810.1371/journal.pone.0062678Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae.Christopher F LoweKevin KatzAllison J McGeerMatthew P MullerToronto ESBL Working GroupOBJECTIVE: We hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates. DESIGN: Retrospective cohort study. SETTING: 12 hospitals (6 screening and 6 non-screening) in Toronto, Canada. PATIENTS: All adult inpatients with an ESBL-E positive culture collected from 2005-2009. METHODS: Cases were defined as hospital-onset (HO) or community-onset (CO) if cultures were positive after or before 72 hours. Efficacy of screening in reducing HO-ESBL-E incidence was assessed with a negative binomial model adjusting for study year and CO-ESBL-E incidence. The accuracy of the HO-ESBL-E definition was assessed by re-classifying HO-ESBL-E cases as confirmed nosocomial (negative admission screen), probable nosocomial (no admission screen) or not nosocomial (positive admission screen) using data from the screening hospitals. RESULTS: There were 2,088 ESBL-E positive patients and incidence of ESBL-E rose from 0.11 to 0.42 per 1,000 inpatient days between 2005 and 2009. CO-ESBL-E incidence was similar at screening and non-screening hospitals but screening hospitals had a lower incidence of HO-ESBL-E in all years. In the negative binomial model, screening was associated with a 49.1% reduction in HO-ESBL-E (p<0.001). A similar reduction was seen in the incidence of HO-ESBL-E bacteremia. When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases. CONCLUSIONS: Admission screening for ESBL-E is associated with a reduced incidence of HO-ESBL-E. Controlled, prospective studies of admission screening for ESBL-E should be a priority.http://europepmc.org/articles/PMC3637447?pdf=render |
| spellingShingle | Christopher F Lowe Kevin Katz Allison J McGeer Matthew P Muller Toronto ESBL Working Group Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. PLoS ONE |
| title | Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. |
| title_full | Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. |
| title_fullStr | Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. |
| title_full_unstemmed | Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. |
| title_short | Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae. |
| title_sort | efficacy of admission screening for extended spectrum beta lactamase producing enterobacteriaceae |
| url | http://europepmc.org/articles/PMC3637447?pdf=render |
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