Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Adult Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
PLoS One. 2023 Jul 25;18(7):e0289163. doi: 10.1371/journal.pone.0289163. eCollection 2023.
Timely identification of patients who carry multidrug-resistant microorganisms (MDRO) is needed to prevent nosocomial spread to other patients and to the hospital environment. We aimed to compare the yield of a universal screening strategy upon admission to the currently installed universal risk assessment combined with risk-based screening upon admission.
This observational study was conducted within a prospective cohort study. From January 1, 2018, until September 1, 2019, patients admitted to our hospital were asked to participate. Nasal and perianal samples were taken upon admission and checked for the presence of MDRO. The results of the universal risk assessment and risk-based screening were collected retrospectively from electronic health records.
In total, 1017 patients with 1069 separate hospital admissions participated in the study. Universal screening identified 38 (3.6%) unknown MDRO carriers upon admission (37 individual patients), all carrying extended-spectrum beta-lactamase-producing Enterobacterales. For 946 of 1069 (88.5%) patients, both the universal risk assessment and universal screening were performed. For 19 (2.0%) admissions, ≥1 risk factor was identified. The universal risk assessment identified one (0.1%) unknown carrier, compared to 37 out of 946 carriers for the universal screening (P<0.001). Of the 37 carriers identified through the universal screening, 35 (94.6%) reported no risk factors.
Our results show that in our low endemic setting, a universal screening strategy identified significantly more MDRO carriers than the currently implemented universal risk-assessment. When implementing a universal risk-assessment, risk factors should be carefully selected to be able to identify ESBL-E carriers. While the universal screening identified more MDRO carriers, further research is needed to determine the cost-effectiveness of this strategy.
及时识别携带多药耐药微生物（MDRO）的患者对于防止医院内传播给其他患者和医院环境至关重要。本研究旨在比较入院时普遍筛查策略与目前普遍采用的入院时基于风险的评估相结合的筛查策略的效果。
本观察性研究在一项前瞻性队列研究中进行。自 2018 年 1 月 1 日至 2019 年 9 月 1 日，我们邀请我院收治的患者参与研究。患者入院时采集鼻拭子和肛周拭子，检测 MDRO 的存在。回顾性地从电子病历中收集普遍风险评估和基于风险的筛查结果。
共有 1017 名患者 1069 次单独住院参与了研究。普遍筛查在入院时发现 38 例（3.6%）未知 MDRO 携带者（37 例个体患者），均携带产超广谱β-内酰胺酶的肠杆菌科。对于 1069 例患者中的 946 例，进行了普遍风险评估和普遍筛查。对于 19 例（2.0%）住院患者，确定了≥1 个危险因素。普遍风险评估发现 1 例（0.1%）未知携带者，而普遍筛查发现 946 例携带者中有 37 例（P<0.001）。在通过普遍筛查发现的 37 例携带者中，有 35 例（94.6%）报告无危险因素。
我们的研究结果表明，在低流行地区，普遍筛查策略比目前实施的普遍风险评估策略能更准确地识别 MDRO 携带者。在实施普遍风险评估时，应仔细选择危险因素，以便识别 ESBL-E 携带者。虽然普遍筛查发现了更多的 MDRO 携带者，但需要进一步研究来确定这种策略的成本效益。
