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Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis.
Am J Infect Control 2015; 43(12):1296-301AJ

Abstract

BACKGROUND

This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE).

METHODS

This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU.

RESULTS

The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09).

CONCLUSIONS

This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission.

Authors+Show Affiliations

Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France; INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Bordeaux, France. Electronic address: alexandre.boyer@chu-bordeaux.fr.Institut de Mathématique, Université Bordeaux, Bordeaux, France.Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.Service d'Hygiène hospitalière, CHU Bordeaux, Bordeaux, France.UMR 5234 CNRS Microbiologie Cellulaire et Moléculaire et Pathogénicité, Université Bordeaux, Bordeaux, France.UMR 5234 CNRS Microbiologie Cellulaire et Moléculaire et Pathogénicité, Université Bordeaux, Bordeaux, France.INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Bordeaux, France.Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France; UMR 5234 CNRS Microbiologie Cellulaire et Moléculaire et Pathogénicité, Université Bordeaux, Bordeaux, France.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

26364520

Citation

Boyer, Alexandre, et al. "Control of Extended-spectrum Β-lactamase-producing Enterobacteriaceae Nosocomial Acquisition in an Intensive Care Unit: a Time Series Regression Analysis." American Journal of Infection Control, vol. 43, no. 12, 2015, pp. 1296-301.
Boyer A, Couallier V, Clouzeau B, et al. Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis. Am J Infect Control. 2015;43(12):1296-301.
Boyer, A., Couallier, V., Clouzeau, B., Lasheras, A., M'zali, F., Kann, M., ... Gruson, D. (2015). Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis. American Journal of Infection Control, 43(12), pp. 1296-301. doi:10.1016/j.ajic.2015.07.026.
Boyer A, et al. Control of Extended-spectrum Β-lactamase-producing Enterobacteriaceae Nosocomial Acquisition in an Intensive Care Unit: a Time Series Regression Analysis. Am J Infect Control. 2015 Dec 1;43(12):1296-301. PubMed PMID: 26364520.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis. AU - Boyer,Alexandre, AU - Couallier,Vincent, AU - Clouzeau,Benjamin, AU - Lasheras,Agnes, AU - M'zali,Fatima, AU - Kann,Michael, AU - Rogues,Anne-Marie, AU - Gruson,Didier, Y1 - 2015/09/11/ PY - 2015/03/24/received PY - 2015/07/15/revised PY - 2015/07/16/accepted PY - 2015/9/15/entrez PY - 2015/9/15/pubmed PY - 2016/10/7/medline KW - Alcohol-based hand rub KW - Enterobacteriaceae KW - Extended-spectrum β-lactamase KW - Intensive care unit KW - Third-generation cephalosporin KW - Time series KW - Workload SP - 1296 EP - 301 JF - American journal of infection control JO - Am J Infect Control VL - 43 IS - 12 N2 - BACKGROUND: This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE). METHODS: This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU. RESULTS: The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09). CONCLUSIONS: This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission. SN - 1527-3296 UR - https://www.unboundmedicine.com/medline/citation/26364520/Control_of_extended_spectrum_β_lactamase_producing_Enterobacteriaceae_nosocomial_acquisition_in_an_intensive_care_unit:_A_time_series_regression_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196-6553(15)00797-X DB - PRIME DP - Unbound Medicine ER -