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Improved quality of care for patients infected or colonised with ESBL-producing Enterobacteriaceae in a French teaching hospital: impact of an interventional prospective study and development of specific tools

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Abstract

The increasing incidence of ESBL-producing Enterobacteriaceae (ESBL-E) in France prompted the publication of national recommendations in 2010. Based on these, we developed a toolkit and a warning system to optimise management of ESBL-E infected or colonised patients in both community and hospital settings. The impact of this initiative on quality of care was assessed in a teaching hospital. The ESBL toolkit was developed in 2011 during multidisciplinary meetings involving a regional network of hospital, private clinic and laboratory staff in Southeastern France. It includes antibiotic treatment protocols, a check list, mail templates and a patient information sheet focusing on infection control. Upon identification of ESBL-E, the warning system involves alerting the attending physician and the infectious disease (ID) advisor, with immediate, advice-based implementation of the toolkit. The procedure and toolkit were tested in our teaching hospital. Patient management was compared before and after implementation of the toolkit over two 3-month periods (July–October 2010 and 2012). Implementation of the ESBL-E warning system and ESBL-E toolkit was tested for 87 patients in 2010 and 92 patients in 2012, resulting in improved patient management: expert advice sought and followed (16 vs 97%), information provided to the patient’s general practitioner (18 vs 63%) and coding of the condition in the patient’s medical file (17 vs 59%), respectively. Our multidisciplinary strategy improved quality of care for in-patients infected or colonised with ESBL-E, increasing compliance with national recommendations.

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Acknowledgements

We thank Brigitte Dunais for her assistance in preparing this manuscript.

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Authors and Affiliations

  1. Infectiologie, Centre Hospitalo-Universitaire de Nice, Nice, France

    Véronique Mondain, Céline Pulcini & Pierre Marie Roger

  2. Pharmacie, Centre Hospitalo-Universitaire de Nice, Nice, France

    Florence Lieutier

  3. Bactériologie, Centre Hospitalo-Universitaire de Nice, Nice, France

    Nicolas Degand, Luce Landraud & Raymond Ruimy

  4. Hygiène, Centre Hospitalo-Universitaire de Nice, Nice, France

    Thierry Fosse

Authors
  1. Véronique Mondain
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  2. Florence Lieutier
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  3. Céline Pulcini
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  4. Nicolas Degand
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  5. Luce Landraud
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  7. Thierry Fosse
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  8. Pierre Marie Roger
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Correspondence to Véronique Mondain.

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Mondain, V., Lieutier, F., Pulcini, C. et al. Improved quality of care for patients infected or colonised with ESBL-producing Enterobacteriaceae in a French teaching hospital: impact of an interventional prospective study and development of specific tools. Eur J Clin Microbiol Infect Dis 37, 977–981 (2018). https://doi.org/10.1007/s10096-018-3234-6

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  • DOI: https://doi.org/10.1007/s10096-018-3234-6

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