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Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization.
Infect Control Hosp Epidemiol. 2009 Jun; 30(6):534-42.IC

Abstract

OBJECTIVE

To determine the rates of and risk factors for carriage and acquisition of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization.

DESIGN

Cohort study.

SETTING

Shaare Zedek Medical Center, a 550-bed teaching hospital.

METHODS

During a 5-month period (February 1-June 30, 2004), 167 (8%) of 1,985 newly admitted general medical patients were enrolled in our study. Nasal, oropharyngeal, and rectal swab specimens were obtained at admission and every 2-3 days until hospital discharge or death. Enterobacteriaceae isolates were tested for ESBL, and Staphylococcus aureus isolates were tested for methicillin resistance.

RESULTS

Of the 167 patients enrolled in our study, 15 (9%) were identified as nasal carriers of methicillin-resistant S. aureus (MRSA) at admission, and 13 (8%) were rectal carriers of ESBL-producing Enterobacteriaceae at admission. Univariate risk factors for rectal carriage of ESBL-producing Enterobacteriaceae included female sex (odds ratio [OR], 11 [95% confidence interval {CI}, 1.4-238]; P < .05), nursing home residence (OR, 6.9 [95% CI, 1.8-27]; P < .01), recent antibiotic treatment (OR, 9.8 [95% CI, 1.7-74]; P < .05), and concomitant nasal carriage of MRSA and/or ESBL-producing Enterobacteriaceae (OR, 5.8 [95% CI, 1.2-26]; P < .01). Multivariate risk factors were female sex and recent antibiotic treatment. During hospitalization, 35 (21%) of 167 patients had acquired rectal carriage of ESBL-producing Enterobacteriaceae (P = .002, for trend analysis). Of the 12 patients who were still in the hospital 2 weeks after admission, 4 (33%) were carriers of ESBL-producing Enterobacteriaceae. Univariate risk factors for acquisition included an age of older than 65 years (P < .005), nursing home residence (OR 2.6, [95% CI, 0.98-2.6]), impaired cognition (OR, 4.8 [95% CI, 1.9-12]), recent antibiotic treatment (OR, 2.7 [95% CI, 0.9-8.3]), respiratory assistance (OR, 4.2 [95% CI, 1.2-14]), and prolonged hospitalization. Multivariate risk factors were an age of older than 65 years and broad-spectrum antibiotic therapy.

CONCLUSIONS

Rectal carriage of ESBL-producing Enterobacteriaceae occurred in 13 (8%) of 167 patients at admission to the medical departments of our hospital and in 4 (33%) of 12 patients still remaining in our hospital after 2 weeks.

Authors+Show Affiliations

Department of Geriatrics, Shaare Zedek Medical Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19419270

Citation

Friedmann, Reuven, et al. "Prospective Evaluation of Colonization With Extended-spectrum Beta-lactamase (ESBL)-producing Enterobacteriaceae Among Patients at Hospital Admission and of Subsequent Colonization With ESBL-producing Enterobacteriaceae Among Patients During Hospitalization." Infection Control and Hospital Epidemiology, vol. 30, no. 6, 2009, pp. 534-42.
Friedmann R, Raveh D, Zartzer E, et al. Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534-42.
Friedmann, R., Raveh, D., Zartzer, E., Rudensky, B., Broide, E., Attias, D., & Yinnon, A. M. (2009). Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. Infection Control and Hospital Epidemiology, 30(6), 534-42. https://doi.org/10.1086/597505
Friedmann R, et al. Prospective Evaluation of Colonization With Extended-spectrum Beta-lactamase (ESBL)-producing Enterobacteriaceae Among Patients at Hospital Admission and of Subsequent Colonization With ESBL-producing Enterobacteriaceae Among Patients During Hospitalization. Infect Control Hosp Epidemiol. 2009;30(6):534-42. PubMed PMID: 19419270.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective evaluation of colonization with extended-spectrum beta-lactamase (ESBL)-producing enterobacteriaceae among patients at hospital admission and of subsequent colonization with ESBL-producing enterobacteriaceae among patients during hospitalization. AU - Friedmann,Reuven, AU - Raveh,David, AU - Zartzer,Esther, AU - Rudensky,Bernard, AU - Broide,Ellen, AU - Attias,Denise, AU - Yinnon,Amos M, PY - 2009/5/8/entrez PY - 2009/5/8/pubmed PY - 2009/7/29/medline SP - 534 EP - 42 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 30 IS - 6 N2 - OBJECTIVE: To determine the rates of and risk factors for carriage and acquisition of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization. DESIGN: Cohort study. SETTING: Shaare Zedek Medical Center, a 550-bed teaching hospital. METHODS: During a 5-month period (February 1-June 30, 2004), 167 (8%) of 1,985 newly admitted general medical patients were enrolled in our study. Nasal, oropharyngeal, and rectal swab specimens were obtained at admission and every 2-3 days until hospital discharge or death. Enterobacteriaceae isolates were tested for ESBL, and Staphylococcus aureus isolates were tested for methicillin resistance. RESULTS: Of the 167 patients enrolled in our study, 15 (9%) were identified as nasal carriers of methicillin-resistant S. aureus (MRSA) at admission, and 13 (8%) were rectal carriers of ESBL-producing Enterobacteriaceae at admission. Univariate risk factors for rectal carriage of ESBL-producing Enterobacteriaceae included female sex (odds ratio [OR], 11 [95% confidence interval {CI}, 1.4-238]; P < .05), nursing home residence (OR, 6.9 [95% CI, 1.8-27]; P < .01), recent antibiotic treatment (OR, 9.8 [95% CI, 1.7-74]; P < .05), and concomitant nasal carriage of MRSA and/or ESBL-producing Enterobacteriaceae (OR, 5.8 [95% CI, 1.2-26]; P < .01). Multivariate risk factors were female sex and recent antibiotic treatment. During hospitalization, 35 (21%) of 167 patients had acquired rectal carriage of ESBL-producing Enterobacteriaceae (P = .002, for trend analysis). Of the 12 patients who were still in the hospital 2 weeks after admission, 4 (33%) were carriers of ESBL-producing Enterobacteriaceae. Univariate risk factors for acquisition included an age of older than 65 years (P < .005), nursing home residence (OR 2.6, [95% CI, 0.98-2.6]), impaired cognition (OR, 4.8 [95% CI, 1.9-12]), recent antibiotic treatment (OR, 2.7 [95% CI, 0.9-8.3]), respiratory assistance (OR, 4.2 [95% CI, 1.2-14]), and prolonged hospitalization. Multivariate risk factors were an age of older than 65 years and broad-spectrum antibiotic therapy. CONCLUSIONS: Rectal carriage of ESBL-producing Enterobacteriaceae occurred in 13 (8%) of 167 patients at admission to the medical departments of our hospital and in 4 (33%) of 12 patients still remaining in our hospital after 2 weeks. SN - 1559-6834 UR - https://www.unboundmedicine.com/medline/citation/19419270/Prospective_evaluation_of_colonization_with_extended_spectrum_beta_lactamase__ESBL__producing_enterobacteriaceae_among_patients_at_hospital_admission_and_of_subsequent_colonization_with_ESBL_producing_enterobacteriaceae_among_patients_during_hospitalization_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&amp;PAGE=linkout&amp;SEARCH=19419270.ui DB - PRIME DP - Unbound Medicine ER -