Infection Control Program, Geneva University Hospitals, Geneva, Switzerland.
Genomic Research Laboratory, Geneva University Hospitals, Geneva, Switzerland.
Crit Care. 2022 Jun 7;26(1):166. doi: 10.1186/s13054-022-04027-8.
Rapid molecular tests could accelerate the control of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and carbapenemase-producing organisms (CPO) in intensive care units (ICUs).
This interventional 12-month cohort study compared a loop-mediated isothermal amplification (LAMP) assay performed directly on rectal swabs with culturing methods (control period, 6 months), during routine ICU screening. Contact precautions (CP) were implemented for CPO or non-E. coli ESBL-producing Enterobacterales (nEcESBL-PE) carriers. Using survival analysis, we compared the time intervals from admission to discontinuation of unnecessary preemptive CP among patients at-risk and the time intervals from screening to implementation of CP among newly identified carriers. We also compared diagnostic performances, and nEcESBL-PE/CPO acquisition rates. This study is registered, ISRCTN 23588440.
We included 1043 patients. During the intervention and control phases, 92/147 (62.6%) and 47/86 (54.7%) of patients at-risk screened at admission were candidates for early discontinuation of preemptive CP. The LAMP assay had a positive predictive value (PPV) of 44.0% and a negative predictive value (NPV) of 99.9% for CPO, and 55.6% PPV and 98.2% NPV for nEcESBL-PE. Due to result notification and interpretation challenges, the median time from admission to discontinuation of preemptive CP increased during the interventional period from 80.5 (95% CI 71.5-132.1) to 88.3 (95% CI 57.7-103.7) hours (p = 0.47). Due to the poor PPV, we had to stop using the LAMP assay to implement CP. No difference was observed regarding the incidence of nEcESBL-PE and CPO acquisition.
A rapid screening strategy with LAMP assays performed directly on rectal swabs had no benefit for infection control in a low-endemicity setting.
快速分子检测可以加速控制重症监护病房（ICU）中产生超广谱β-内酰胺酶的肠杆菌科（ESBL-PE）和产碳青霉烯酶的生物体（CPO）。
这项干预性 12 个月队列研究比较了直肠拭子直接进行环介导等温扩增（LAMP）检测与培养方法（对照期 6 个月），在常规 ICU 筛查期间。对 CPO 或非大肠埃希菌 ESBL 产生的肠杆菌科（nEcESBL-PE）携带者实施接触预防措施（CP）。使用生存分析，我们比较了有风险的患者从入院到取消不必要的预防性 CP 的时间间隔，以及新发现的携带者从筛查到实施 CP 的时间间隔。我们还比较了诊断性能和 nEcESBL-PE/CPO 的获得率。这项研究已注册，ISRCTN 23588440。
我们纳入了 1043 名患者。在干预和对照阶段，入院时筛查的 147 名有风险的患者中有 92 名（62.6%）和 86 名患者中有 47 名（54.7%）为 CPO 早期停止预防性 CP 的候选者。LAMP 检测对 CPO 的阳性预测值（PPV）为 44.0%，阴性预测值（NPV）为 99.9%，对 nEcESBL-PE 的 PPV 为 55.6%，NPV 为 98.2%。由于结果通知和解释方面的挑战，干预期间从入院到取消预防性 CP 的中位时间从 80.5（95%CI 71.5-132.1）增加到 88.3（95%CI 57.7-103.7）小时（p=0.47）。由于较差的 PPV，我们不得不停止使用 LAMP 检测来实施 CP。nEcESBL-PE 和 CPO 获得的发生率没有差异。
在低流行地区，直肠拭子直接进行快速筛选策略对感染控制没有益处。
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