Epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an intensive care unit with no single rooms
| العنوان: | Epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an intensive care unit with no single rooms |
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| المؤلفون: | Cyril Charron, Sophie Paktoris-Papine, Xavier Repessé, Guillaume Geri, Aurélien Dinh, Faten El Sayed, Margaux Artiguenave, Florence Espinasse, Antoine Vieillard-Baron |
| المصدر: | Annals of Intensive Care Annals of Intensive Care, Vol 7, Iss 1, Pp 1-9 (2017) |
| بيانات النشر: | Springer Science and Business Media LLC, 2017. |
| سنة النشر: | 2017 |
| مصطلحات موضوعية: | 0301 basic medicine, medicine.medical_specialty, Univariate analysis, Isolation (health care), business.industry, Research, Incidence (epidemiology), 030106 microbiology, lcsh:Medical emergencies. Critical care. Intensive care. First aid, lcsh:RC86-88.9, bacterial infections and mycoses, Critical Care and Intensive Care Medicine, Intensive care unit, law.invention, 03 medical and health sciences, 0302 clinical medicine, Carriage, SAPS II, law, Epidemiology, Emergency medicine, Medicine, 030212 general & internal medicine, Risk factor, business |
| الوصف: | Background The transmission of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBL) is prevented by additional contact precautions, mainly relying on isolation in a single room and hand hygiene. Contact isolation cannot be achieved in our 12-bed ICU, which has only double rooms. We report the epidemiology of ESBL imported, acquired and transmitted in an ICU with no single rooms. Methods We prospectively conducted an observational and non-interventional study in a French 12-bed ICU. Inclusion criteria were patients >18 years of age treated by at least two successive nursing teams. Patient characteristics at admission and clinical data during hospital stay were collected prospectively. ESBL carriage was monitored using rectal swabs collected at admission and once weekly during the ICU stay. Potential cross-transmission was studied (1) by identifying index patients defined as possible ESBL sources for transmission, (2) by classifying each ESBL strain according to the cefotaximase München (CTXM) 1 and 9 groups and (3) by gene sequencing for remaining cases of possible transmission. Results From June 2014 to April 2015, of 550 patients admitted to the ICU, 470 met the inclusion criteria and 221 had at least two rectal swabs. The rate of ESBL colonization, mainly by Escherichia coli, at admission was 13.2%. The incidence of ESBL acquisition, mainly with E. coli too, was 4.1%. Mortality did not differ between ESBL carriers and non-carriers. In univariate analysis, ESBL acquisition was associated with male gender, SAPS II, SOFA, chronic kidney disease at admission, duration of mechanical ventilation, need for catecholamine and the ICU LOS. In multivariate analysis, SAPS II at admission was the only risk factor for ESBL acquisition. We confirmed cross-transmission, emanating from the same index patient, in two of the nine patients with ESBL acquisition (0.8%, 2/221). No case of cross-transmission in the same double room was observed. Discussion and conclusion Prevalence of ESBL colonization in our ICU was 13.2%. Despite the absence single rooms, the incidence of ESBL acquisition was 4.1% and cross-transmission was proven in only two cases, resulting from the same index patient who was not hospitalized in the same double room. Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0295-0) contains supplementary material, which is available to authorized users. |
| تدمد: | 2110-5820 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::5c1e8a6d15c69a363f686e9f322f0575Test https://doi.org/10.1186/s13613-017-0295-0Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....5c1e8a6d15c69a363f686e9f322f0575 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 21105820 |
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