Department of Medical Microbiology, Saltro, Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
Department of Medical Microbiology, Bronovo Hospital, Den Haag, and Diaconessenhuis, Leiden, The Netherlands.
Clin Microbiol Infect. 2015 Feb;21(2):141-6. doi: 10.1016/j.cmi.2014.09.014. Epub 2014 Oct 29.
The prevalence of patients colonized with extended-spectrum beta-lactamase (ESBL)-producing bacteria increases, especially in long-term-care facilities (LTCFs). Identification of ESBL carriers at hospital admission is relevant for infection control measures and antibiotic therapy for nosocomial infections. We aimed to develop a prediction rule for ESBL carriage at hospital admission for patients admitted from home and LTCFs, and to quantify incidences of nosocomial infections caused by ESBL-producing bacteria. The ESBL-carrier status was determined of patients admitted from LTCFs and from home settings in four hospitals in the Netherlands using perianal swabs obtained within 48 hours of admission. Risk factors for ESBL carriage were assessed. Infections caused by ESBL-producing bacteria were identified retrospectively. Among 1351 patients, 111 (8.2%) were ESBL carriers at admission: 50/579 (8.6%) admitted from LTCFs and 61/772 (7.9%) from home settings (p 0.63). Previous ESBL carriage and previous hospital admission were risk factors for ESBL carriage in multivariable analysis. The area under the curve of the receiver operating characteristic curve of the model was 0.64 (95% CI 0.58-0.71). Presence of ≥1 risk factor (n = 803; 59%) had sensitivity of 72%. Incidences of nosocomial infections caused by ESBL-producing bacteria were 45.5/10,000 and 2.1/10,000 admission days for ESBL carriers and non-carriers, respectively (p <0.05). In conclusion, prevalence of ESBL carriage at hospital admission was 8.2%, and was comparable among patients admitted from LTCF and home. A clinically useful prediction rule for ESBL carriage at admission could not be developed. The absolute incidence of nosocomial infections by ESBL-producing bacteria was low, but higher among patients carrying ESBL-producing bacteria at the time of hospital admission.
产超广谱β-内酰胺酶（ESBL）细菌定植患者的患病率增加，尤其是在长期护理机构（LTCF）中。在入院时识别 ESBL 携带者对于医院感染的控制措施和抗生素治疗具有重要意义。我们旨在为从家中和 LTCF 入院的患者制定一个入院时 ESBL 携带的预测规则，并量化由产 ESBL 细菌引起的医院感染的发生率。使用入院后 48 小时内获得的肛周拭子，在荷兰四家医院从 LTCF 和家庭环境中入院的患者中确定 ESBL 携带者状态。评估了 ESBL 携带的危险因素。回顾性鉴定由产 ESBL 细菌引起的感染。在 1351 名患者中，111 名（8.2%）入院时携带 ESBL：50/579 名（8.6%）来自 LTCF，61/772 名（7.9%）来自家庭环境（p=0.63）。多变量分析显示，既往 ESBL 携带和既往住院是 ESBL 携带的危险因素。该模型的受试者工作特征曲线下面积为 0.64（95%CI 0.58-0.71）。存在≥1个危险因素（n=803；59%）的敏感性为 72%。ESBL 携带者和非携带者的医院感染发生率分别为 45.5/10000 和 2.1/10000 入院日（p<0.05）。结论，入院时 ESBL 携带率为 8.2%，LTCF 和家庭入院患者之间相似。无法制定用于入院时 ESBL 携带的临床有用的预测规则。产 ESBL 细菌引起的医院感染的绝对发生率较低，但在入院时携带 ESBL 细菌的患者中较高。
