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Extended-spectrum β-lactamase-producing Enterobacteriaceae in French nursing homes: an association between high carriage rate among residents, environmental contamination, poor conformity with good hygiene practice, and putative resident-to-resident transmission.
Infect Control Hosp Epidemiol 2014; 35(4):384-9IC

Abstract

OBJECTIVE

We evaluated the spread of multidrug-resistant Enterobacteriaceae in 38 nursing homes (NHs) in the Centre region of France.

METHODS

We conducted a multicenter prevalence study and evaluated extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae (ESBLE and CPE, respectively) colonization of 1,155 residents. The colonizing isolates were studied by randomly amplified polymorphic DNA typing. We observed hygiene practices and studied the contamination of the environment in 8 NHs.

RESULTS

A total of 114 residents were ESBLE carriers (9.9%); none were CPE carriers. A total of 82.6% of the ESBLE were Escherichia coli. ESBLE colonization was associated with poor health status (P = .002), malignancy (P = .006), urinary incontinence (P = .007), fecal incontinence (P = .002), previous hospitalization (P = .033), and carbapenem treatment (P = .040). The clonal relationship between isolates within NHs suggested resident-to-resident ESBLE transmission in 15 NHs. ESBLE isolates were recovered from 6 of 232 bedrooms studied. A total of 1,533 observations revealed low rates of conformity for hand hygiene (25.7%), the use of gloves (45.9%) and protective clothing (13.3%), and waste management (46.7%). Conformity rates correlated inversely with ESBLE carriage rates.

CONCLUSIONS

In most of the participating NHs, improved application of standard precautions during incontinence care is needed, and greater efforts to clean the environment of residents are required.

Authors+Show Affiliations

Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24602943

Citation

Cochard, Hélène, et al. "Extended-spectrum Β-lactamase-producing Enterobacteriaceae in French Nursing Homes: an Association Between High Carriage Rate Among Residents, Environmental Contamination, Poor Conformity With Good Hygiene Practice, and Putative Resident-to-resident Transmission." Infection Control and Hospital Epidemiology, vol. 35, no. 4, 2014, pp. 384-9.
Cochard H, Aubier B, Quentin R, et al. Extended-spectrum β-lactamase-producing Enterobacteriaceae in French nursing homes: an association between high carriage rate among residents, environmental contamination, poor conformity with good hygiene practice, and putative resident-to-resident transmission. Infect Control Hosp Epidemiol. 2014;35(4):384-9.
Cochard, H., Aubier, B., Quentin, R., & van der Mee-Marquet, N. (2014). Extended-spectrum β-lactamase-producing Enterobacteriaceae in French nursing homes: an association between high carriage rate among residents, environmental contamination, poor conformity with good hygiene practice, and putative resident-to-resident transmission. Infection Control and Hospital Epidemiology, 35(4), pp. 384-9. doi:10.1086/675599.
Cochard H, et al. Extended-spectrum Β-lactamase-producing Enterobacteriaceae in French Nursing Homes: an Association Between High Carriage Rate Among Residents, Environmental Contamination, Poor Conformity With Good Hygiene Practice, and Putative Resident-to-resident Transmission. Infect Control Hosp Epidemiol. 2014;35(4):384-9. PubMed PMID: 24602943.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Extended-spectrum β-lactamase-producing Enterobacteriaceae in French nursing homes: an association between high carriage rate among residents, environmental contamination, poor conformity with good hygiene practice, and putative resident-to-resident transmission. AU - Cochard,Hélène, AU - Aubier,Benjamin, AU - Quentin,Roland, AU - van der Mee-Marquet,Nathalie, AU - ,, PY - 2014/3/8/entrez PY - 2014/3/8/pubmed PY - 2014/12/15/medline SP - 384 EP - 9 JF - Infection control and hospital epidemiology JO - Infect Control Hosp Epidemiol VL - 35 IS - 4 N2 - OBJECTIVE: We evaluated the spread of multidrug-resistant Enterobacteriaceae in 38 nursing homes (NHs) in the Centre region of France. METHODS: We conducted a multicenter prevalence study and evaluated extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae (ESBLE and CPE, respectively) colonization of 1,155 residents. The colonizing isolates were studied by randomly amplified polymorphic DNA typing. We observed hygiene practices and studied the contamination of the environment in 8 NHs. RESULTS: A total of 114 residents were ESBLE carriers (9.9%); none were CPE carriers. A total of 82.6% of the ESBLE were Escherichia coli. ESBLE colonization was associated with poor health status (P = .002), malignancy (P = .006), urinary incontinence (P = .007), fecal incontinence (P = .002), previous hospitalization (P = .033), and carbapenem treatment (P = .040). The clonal relationship between isolates within NHs suggested resident-to-resident ESBLE transmission in 15 NHs. ESBLE isolates were recovered from 6 of 232 bedrooms studied. A total of 1,533 observations revealed low rates of conformity for hand hygiene (25.7%), the use of gloves (45.9%) and protective clothing (13.3%), and waste management (46.7%). Conformity rates correlated inversely with ESBLE carriage rates. CONCLUSIONS: In most of the participating NHs, improved application of standard precautions during incontinence care is needed, and greater efforts to clean the environment of residents are required. SN - 1559-6834 UR - https://www.unboundmedicine.com/medline/citation/24602943/Extended_spectrum_β_lactamase_producing_Enterobacteriaceae_in_French_nursing_homes:_an_association_between_high_carriage_rate_among_residents_environmental_contamination_poor_conformity_with_good_hygiene_practice_and_putative_resident_to_resident_transmission_ L2 - http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=linkout&SEARCH=24602943.ui DB - PRIME DP - Unbound Medicine ER -