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Clinical predictive values of extended-spectrum beta-lactamase carriage in patients admitted to medical wards

European Journal of Clinical Microbiology & Infectious Diseases volume 31, pages 319–325 (2012)Cite this article

Abstract

We aimed to reassess, through clinical items, populations at risk for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage at admission to hospital and to assess the risk of further positive clinical culture of ESBL-E among carriers. We performed a 5-month cohort study in a medicine ward of a 500-bed university teaching hospital in the Parisian area of France. All admitted patients were prospectively enrolled for rectal swabbing and clinical data collection, including bacterial infection at admission and during stay. Variables associated with ESBL-E carriage were identified by univariate and multivariate analysis. Five hundred patients were included. The prevalence of ESBL-E was 6.6% (33/500) upon admission. Only previous carriage of multidrug-resistant bacteria (MDRB) was associated with carriage (odds ratio [OR]: 17.7, 95% confidence interval (CI) 5.8–54.2, p < 0.001), yet, the positive predictive value (PPV) was not higher than 50%. When prior MDRB carriage was not considered in the multivariate analysis, only prior antibiotic consumption was found to be associated with carriage at admission (OR: 2.2 [1.1–4.5], p = 0.02). Two patients had ESBL-E infection at admission, yet, no patient became infected with ESBL-E during their stay. The clinical prediction of ESBL carriage at admission in our wards was found to be poorly efficient for assessing the at-risk population.

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References

  1. Pitout JD, Laupland KB (2008) Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 8:159–166

    PubMed  Article  CAS  Google Scholar 

  2. Knothe H, Shah P, Krcmery V, Antal M, Mitsuhashi S (1983) Transferable resistance to cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. Infection 11:315–317

    PubMed  Article  CAS  Google Scholar 

  3. Sirot D, Sirot J, Labia R, Morand A, Courvalin P, Darfeuille-Michaud A, Perroux R, Cluzel R (1987) Transferable resistance to third-generation cephalosporins in clinical isolates of Klebsiella pneumoniae: identification of CTX-1, a novel beta-lactamase. J Antimicrob Chemother 20:323–334

    PubMed  Article  CAS  Google Scholar 

  4. Branger C, Bruneau B, Lesimple AL, Bouvet PJ, Berry P, Sevali-Garcia J, Lambert-Zechovsky N (1997) Epidemiological typing of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates responsible for five outbreaks in a university hospital. J Hosp Infect 36:23–36

    PubMed  Article  CAS  Google Scholar 

  5. Mammeri H, Laurans G, Eveillard M, Castelain S, Eb F (2001) Coexistence of SHV-4- and TEM-24-producing Enterobacter aerogenes strains before a large outbreak of TEM-24-producing strains in a French hospital. J Clin Microbiol 39:2184–2190

    PubMed  Article  CAS  Google Scholar 

  6. Lucet JC, Decré D, Fichelle A, Joly-Guillou ML, Pernet M, Deblangy C, Kosmann MJ, Régnier B (1999) Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a university hospital. Clin Infect Dis 29:1411–1418

    PubMed  Article  CAS  Google Scholar 

  7. Ben-Ami R, Schwaber MJ, Navon-Venezia S, Schwartz D, Giladi M, Chmelnitsky I, Leavitt A, Carmeli Y (2006) Influx of extended-spectrum beta-lactamase-producing Enterobacteriaceae into the hospital. Clin Infect Dis 42:925–934

    PubMed  Article  CAS  Google Scholar 

  8. Pitout JD, Hanson ND, Church DL, Laupland KB (2004) Population-based laboratory surveillance for Escherichia coli-producing extended-spectrum beta-lactamases: importance of community isolates with bla CTX-M genes. Clin Infect Dis 38:1736–1741

    PubMed  Article  CAS  Google Scholar 

  9. Rodríguez-Baño J, Alcalá JC, Cisneros JM, Grill F, Oliver A, Horcajada JP, Tórtola T, Mirelis B, Navarro G, Cuenca M, Esteve M, Peña C, Llanos AC, Cantón R, Pascual A (2008) Community infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Arch Intern Med 168:1897–1902

    PubMed  Article  Google Scholar 

  10. Ruppé E, Hem S, Lath S, Gautier V, Ariey F, Sarthou JL, Monchy D, Arlet G (2009) CTX-M beta-lactamases in Escherichia coli from community-acquired urinary tract infections, Cambodia. Emerg Infect Dis 15:741–748

    PubMed  Article  Google Scholar 

  11. Friedmann R, Raveh D, Zartzer E, Rudensky B, Broide E, Attias D, Yinnon AM (2009) Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing Enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol 30:534–542

    PubMed  Article  Google Scholar 

  12. Laupland KB, Church DL, Vidakovich J, Mucenski M, Pitout JD (2008) Community-onset extended-spectrum beta-lactamase (ESBL) producing Escherichia coli: importance of international travel. J Infect 57:441–448

    PubMed  Article  Google Scholar 

  13. Pitout JD, Campbell L, Church DL, Gregson DB, Laupland KB (2009) Molecular characteristics of travel-related extended-spectrum-beta-lactamase-producing Escherichia coli isolates from the Calgary Health Region. Antimicrob Agents Chemother 53:2539–2543

    PubMed  Article  CAS  Google Scholar 

  14. Tängdén T, Cars O, Melhus A, Löwdin E (2010) Foreign travel is a major risk factor for colonization with Escherichia coli producing CTX-M-type extended-spectrum beta-lactamases: a prospective study with Swedish volunteers. Antimicrob Agents Chemother 54:3564–3568

    PubMed  Article  Google Scholar 

  15. Safdar N, Marx J, Meyer NA, Maki DG (2006) Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 34:476–483

    PubMed  Article  Google Scholar 

  16. Miró E, Mirelis B, Navarro F, Rivera A, Mesa RJ, Roig MC, Gómez L, Coll P (2005) Surveillance of extended-spectrum beta-lactamases from clinical samples and faecal carriers in Barcelona, Spain. J Antimicrob Chemother 56:1152–1155

    PubMed  Article  Google Scholar 

  17. Rooney PJ, O’Leary MC, Loughrey AC, McCalmont M, Smyth B, Donaghy P, Badri M, Woodford N, Karisik E, Livermore DM (2009) Nursing homes as a reservoir of extended-spectrum beta-lactamase (ESBL)-producing ciprofloxacin-resistant Escherichia coli. J Antimicrob Chemother 64:635–641

    PubMed  Article  CAS  Google Scholar 

  18. March A, Aschbacher R, Dhanji H, Livermore DM, Böttcher A, Sleghel F, Maggi S, Noale M, Larcher C, Woodford N (2010) Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria. Clin Microbiol Infect 16:934–944

    PubMed  CAS  Google Scholar 

  19. Murk JL, Heddema ER, Hess DL, Bogaards JA, Vandenbroucke-Grauls CM, Debets-Ossenkopp YJ (2009) Enrichment broth improved detection of extended-spectrum-beta-lactamase-producing bacteria in throat and rectal surveillance cultures of samples from patients in intensive care units. J Clin Microbiol 47:1885–1887

    PubMed  Article  CAS  Google Scholar 

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Acknowledgments

We are grateful to the teams of the Internal Medicine, Cardiology, Geriatrics, and Oncology wards for their active collaboration in this work. This work was supported in part by public funding from EA3964 (Faculté de Médecine Paris Diderot, Paris, France) and by the Centre National de Référence Associé “Résistance dans les flores commensales”.

Conflicts of interest

All authors: none.

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Affiliations

  1. EA3964, Faculté de Médecine Paris Diderot, Paris, France

    E. Ruppé, A. Pitsch, V. de Lastours, F. Chau, A. Andremont & B. Fantin

  2. Centre National de Référence Associé “Résistance dans les flores commensales”, Laboratoire de Bactériologie, Hôpital Bichat-Claude Bernard, AP-HP, 46 Rue Henri Huchard, 75018, Paris, France

    E. Ruppé, A. Pitsch & A. Andremont

  3. Unité de Recherche Clinique Paris Nord, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France

    F. Tubach & B. Pasquet

  4. Service de Médecine Interne, Hôpital Beaujon, AP-HP, Clichy, France

    V. de Lastours & B. Fantin

  5. Unité de Lutte Contre les Infections Nosocomiales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France

    J.-C. Lucet

Authors
  1. E. Ruppé
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  2. A. Pitsch
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  3. F. Tubach
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  4. V. de Lastours
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  5. F. Chau
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  6. B. Pasquet
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  7. J.-C. Lucet
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  8. A. Andremont
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  9. B. Fantin
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Correspondence to E. Ruppé.

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Ruppé, E., Pitsch, A., Tubach, F. et al. Clinical predictive values of extended-spectrum beta-lactamase carriage in patients admitted to medical wards. Eur J Clin Microbiol Infect Dis 31, 319–325 (2012). https://doi.org/10.1007/s10096-011-1313-z

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  • DOI: https://doi.org/10.1007/s10096-011-1313-z

Keywords

  • Medical Ward
  • Antibiotic Consumption
  • Charlson Comorbidity Index Score
  • Contact Precaution
  • ESBL Carriage