Duration of colonization by extended-spectrum β-lactamase-producing Enterobacteriaceae after hospital discharge

Birgand, Gabriel; Armand-Lefèvre, Laurence; Lolom, Isabelle; Ruppé, Étienne; Andremont, Antoine; Lucet, Jean‐Christophe

doi:10.1016/j.ajic.2012.05.015

Cited by 68 publications

(57 citation statements)

References 23 publications

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“…78 In a French university hospital, having the first positive culture on screening samples only (compared to clinical ± screening samples) was associated with ESBL-E clearance at readmission. 79 Similarly, among KPC-producing CRE carriers in a university hospital in Israel, the index culture being a clinical culture (vs surveillance culture) was associated with longer mean time to negativity. 87 Recurrent hospitalization between the first and last culture was also associated with a longer time to clearance of CRE colonization.…”

Section: Patient Groups At Risk For Prolonged Colonizationmentioning

confidence: 99%

“…The gastrointestinal tract sampling was included in nearly all of these studies. Most studies evaluating duration of colonization with MDR-E utilized stool samples, 78,80,82,86,88 perirectal swab samples, 21,79,81,84 or either. 23,85 Original sites of infection were tested (if still relevant) in one study, 21 and another study included cultures of samples obtained from multiple anatomic sites (ie, forehead, axillae, finger webs, groin, toe webs, and perirectal area).…”

Section: Sites Of Colonizationmentioning

confidence: 99%

“…78 In a French university hospital cohort (n = 448) undergoing routine active surveillance on admission for previous positive culture, 40% were still colonized at first readmission; 25.6% were still colonized after 1 year, and 8.9% were still colonized after 2 years, with a median time to ESBL-E clearance (single negative rectal swab) of 6.6 months (range, 3.4-13.4 months). 79,91 CRE. In a postdischarge surveillance study of tertiary-care hospital and long-term care facility patients infected or colonized with KPC-Klebsiella pneumoniae in Israel, resolution of carriage (defined as 2 consecutive negative cultures and blaKPC-PCR tests with no subsequent positive test) occurred in 65 of 125 (52%) patients followed for 5 months.…”

Section: Duration Of Colonizationmentioning

confidence: 99%

“…[21][22][23][78][79][80][81][82][83][84][85][86][87][88][89][90] Most studies were conducted in the acute-care setting [21][22][23][79][80][81]83,85,87,[89][90][91] and identified a population of patients infected and/or colonized with MDR-E, either ESBL-E or CRE, or MDR-Enterobacteriaceae defined by resistance to multiple classes of drugs. Patients were assessed for persistence of colonization at study-specific intervals and variable durations of follow-up.…”

Section: Duration Of Colonizationmentioning

confidence: 99%

“…Patients were assessed for persistence of colonization at study-specific intervals and variable durations of follow-up. The definition of "clearance" varied between a single negative screening culture, 79,87,90 at least 2 negative screening cultures, 21,23,81,84 or at least 3 negative screening cultures swabs. 80,85,91 ESBL-E.…”

Section: Duration Of Colonizationmentioning

confidence: 99%

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Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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Section: Patient Groups At Risk For Prolonged Colonizationmentioning

confidence: 99%

Section: Sites Of Colonizationmentioning

confidence: 99%

Section: Duration Of Colonizationmentioning

confidence: 99%

Section: Duration Of Colonizationmentioning

confidence: 99%

Section: Duration Of Colonizationmentioning

confidence: 99%

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Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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Mortality Due to Nosocomial Infection with Klebsiella pneumoniae ESBL+

Starzyk-Łuszcz¹,

Zielonka

Jakubik³

et al. 2017

Advances in Experimental Medicine and Biology

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Klebsiella pneumoniae is one of the most important hospital pathogens, particularly concerning the multidrug-resistant strain ESBL. The aim of this study was to evaluate nosocomial infections with K. pneumoniae ESBL in the context of infection location, risk factors, and prognosis. This hospital study was conducted retrospectively and covered a 3 months' period. The infection with K. pneumoniae ESBL was diagnosed in 36 patients (19 women and 17 men) of the mean age of 74.2 ± 14.8 years. The number of infected patients amounted to 2.2% of all patients admitted to Czerniakowski Hospital in Warsaw, Poland, over the study time. Twenty of these patients died (13 women and 7 men), representing 14% of all hospital deaths at the time. The infection with K. pneumoniae ESBL occurred most frequently in the department of internal diseases, and rarely in neurology or intensive care wards. Bacteria was most often isolated from the urine, with the most distinct association between the use of urinary catheters and death (p = 0.019). We conclude that infections with K. pneumoniae ESBL were associated with over 55% mortality and usually occurred in the setting of internal diseases. Deaths due to K. pneumoniae ESBL infection were significantly related to the use of urinary bladder catheters.

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