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Prospective Evaluation of Colonization with Extended-Spectrum β-Lactamase (ESBL)–Producing Enterobacteriaceae Among Patients at Hospital Admission and of Subsequent Colonization with ESBL-Producing Enterobacteriaceae Among Patients During Hospitalization

Published online by Cambridge University Press:  02 January 2015

Reuven Friedmann ,
David Raveh ,
Esther Zartzer ,
Bernard Rudensky ,
Ellen Broide ,
Denise Attias  and
Amos M. Yinnon
Reuven Friedmann
Affiliation:
Department of Geriatrics, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
David Raveh
Affiliation:
Infectious Disease Unit, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
Esther Zartzer
Affiliation:
Department of Geriatrics, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel Infectious Disease Unit, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
Bernard Rudensky
Affiliation:
Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
Ellen Broide
Affiliation:
Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
Denise Attias
Affiliation:
Clinical Microbiology Laboratory, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
Amos M. Yinnon*
Affiliation:
Infectious Disease Unit, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel
*
Division of Medicine, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel([email protected])
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Abstract

Objective.

To determine the rates of and risk factors for carriage and acquisition of extended-spectrum (β-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization.

Design.

Cohort study.

Setting.

Shaare Zedek Medical Center, a 550-bed teaching hospital.

Methods.

During a 5-month period (February 1-June 30, 2004), 167 (8%) of 1,985 newly admitted general medical patients were enrolled in our study. Nasal, oropharyngeal, and rectal swab specimens were obtained at admission and every 2-3 days until hospital discharge or death. Enterobacteriaceae isolates were tested for ESBL, and Staphylococcus aureus isolates were tested for methicillin resistance.

Results.

Of the 167 patients enrolled in our study, 15 (9%) were identified as nasal carriers of methicillin-resistant S. aureus (MRSA) at admission, and 13 (8%) were rectal carriers of ESBL-producing Enterobacteriaceae at admission. Univariate risk factors for rectal carriage of ESBL-producing Enterobacteriaceae included female sex (odds ratio [OR], 11 [95% confidence interval {CI}, 1.4—238]; P < .05), nursing home residence (OR, 6.9 [95% CI, 1.8-27]; P < .01), recent antibiotic treatment (OR, 9.8 [95% CI, 1.7-74]; P < .05), and concomitant nasal carriage of MRSA and/or ESBL-producing Enterobacteriaceae (OR, 5.8 [95% CI, 1.2-26]; P < .01). Multivariate risk factors were female sex and recent antibiotic treatment. During hospitalization, 35 (21%) of 167 patients had acquired rectal carriage of ESBL-producing Enterobacteriaceae (P = .002, for trend analysis). Of the 12 patients who were still in the hospital 2 weeks after admission, 4 (33%) were carriers of ESBL-producing Enterobacteriaceae. Univariate risk factors for acquisition included an age of older than 65 years (P < .005), nursing home residence (OR 2.6, [95% CI, 0.98-2.6]), impaired cognition (OR, 4.8 [95% CI, 1.9-12]), recent antibiotic treatment (OR, 2.7 [95% CI, 0.9-8.3]), respiratory assistance (OR, 4.2 [95% CI, 1.2-14]), and prolonged hospitalization. Multivariate risk factors were an age of older than 65 years and broad-spectrum antibiotic therapy.

Conclusions.

Rectal carriage of ESBL-producing Enterobacteriaceae occurred in 13 (8%) of 167 patients at admission to the medical departments of our hospital and in 4 (33%) of 12 patients still remaining in our hospital after 2 weeks.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 6 , June 2009 , pp. 534 - 542
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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