Medical Intensive Care Unit, La Source Hospital, CHR Orléans, Orléans, France.
Department of Microbiology, Bacteriology Unit, La Source Hospital, CHR Orléans, Orléans, France.
Clin Microbiol Infect. 2018 Apr;24(4):429.e7-429.e12. doi: 10.1016/j.cmi.2017.08.005. Epub 2017 Sep 26.
The usefulness of screening for carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) with active surveillance cultures (ASC) remains equivocal in low-endemicity intensive care units (ICUs). Our primary objective was to appraise the impact of ceasing ASC on the incidence of ICU-acquired ESBL-E infections in an ICU with universal contact precautions (CP). Patient outcomes and carbapenem consumption were also investigated.
A single-ICU, retrospective, uncontrolled before-and-after study including all patients admitted for ≥3 days during two consecutive 1-year periods with and without ASC.
A total of 524 and 545 patients were included during the ASC and the no-ASC periods, respectively. Twenty-eight patients (5.3%) from the ASC period were ESBL-E carriers. An ICU-acquired ESBL-E infection (median duration of risk exposure, 4 (range 2-9) days for both periods) occurred in 1.1% and 1.5% of patients admitted during the ASC and the no-ASC periods (p = 0.64), with no inter-period variation in incidence after adjustment on competing risks of death and ICU discharge (standardized hazard ratio (SHR) 2.32, 95% CI 0.80-6.73, p = 0.12). An admission during the no-ASC period exerted no independent impact on the hazards of ESBL-E infections (adjusted OR 1.16, 95% CI 0.38-3.50, p = 0.79), in-ICU death (SHR 1.22, 95% CI 0.93-1.59, p = 0.15) and extended length of stay (SHR for discharge 0.89, 95% CI 0.79-1.01, p = 0.08). Carbapenem exposure in patients without ESBL-E infection decreased between the ASC and no-ASC periods (75 versus 61 carbapenem-days per 1000 patient-days, p = 0.01).
In a low-endemicity ICU with universal CP, the withdrawal of routine screening for ESBL-E carriage had no significant effect on the incidence of ICU-acquired ESBL-E infections and patient outcomes. Carbapenem consumption decreased in patients without ESBL-E infection.
在低流行地区的重症监护病房（ICU）中，主动监测培养（ASC）筛查产超广谱β-内酰胺酶肠杆菌科（ESBL-E）携带的效果仍存在争议。我们的主要目的是评估在普遍接触预防（CP）的 ICU 中停止 ASC 对 ICU 获得性 ESBL-E 感染发生率的影响。还调查了患者结局和碳青霉烯类药物的使用情况。
这是一项单 ICU、回顾性、无对照的前后对照研究，纳入了连续两年两个时间段内入住 ICU 且入住时间≥3 天的所有患者，这两个时间段分别进行了 ASC 和不进行 ASC。
ASC 期间和不进行 ASC 期间分别纳入了 524 例和 545 例患者。ASC 期间有 28 例（5.3%）患者为 ESBL-E 携带者。在 ASC 期间和不进行 ASC 期间，ICU 获得性 ESBL-E 感染（风险暴露的中位持续时间分别为 4 天[范围 2-9 天]）分别发生在 1.1%和 1.5%的患者中（p=0.64），在排除死亡和 ICU 出院的竞争风险后，两个时间段的感染发生率没有差异（标准化风险比（SHR）2.32，95%CI 0.80-6.73，p=0.12）。在不进行 ASC 期间入院不会对 ESBL-E 感染的风险产生独立影响（调整后的比值比（OR）1.16，95%CI 0.38-3.50，p=0.79）、ICU 内死亡（SHR 1.22，95%CI 0.93-1.59，p=0.15）和延长的住院时间（SHR 出院 0.89，95%CI 0.79-1.01，p=0.08）。无 ESBL-E 感染的患者的碳青霉烯类药物暴露在 ASC 期间和不进行 ASC 期间有所减少（每 1000 个患者日的碳青霉烯类药物天数分别为 75 天和 61 天，p=0.01）。
在普遍采用 CP 的低流行地区 ICU 中，停止常规筛查 ESBL-E 携带不会显著影响 ICU 获得性 ESBL-E 感染的发生率和患者结局。无 ESBL-E 感染的患者的碳青霉烯类药物使用减少。
