Epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an intensive care unit with no single rooms

Abstract

Background:The transmission of extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBL) is prevented by additional contact precautions, mainly relying on isolation in a single room and hand hygiene. Contact isolation cannot be achieved in our 12-bed ICU, which has only double rooms. We report the epidemiology of ESBL imported, acquired and transmitted in an ICU with no single rooms. Methods:We prospectively conducted an observational and non-interventional study in a French 12-bed ICU. Inclusion criteria were patients >18 years of age treated by at least two successive nursing teams. Patient characteristics at admission and clinical data during hospital stay were collected prospectively. ESBL carriage was monitored using rectal swabs collected at admission and once weekly during the ICU stay. Potential cross-transmission was studied (1) by identifying index patients defined as possible ESBL sources for transmission, (2) by classifying each ESBL strain according to the cefotaximase München (CTX M ) 1 and 9 groups and (3) by gene sequencing for remaining cases of possible transmission.Results: From June 2014 to April 2015, of 550 patients admitted to the ICU, 470 met the inclusion criteria and 221 had at least two rectal swabs. The rate of ESBL colonization, mainly by Escherichia coli, at admission was 13.2%. The incidence of ESBL acquisition, mainly with E. coli too, was 4.1%. Mortality did not differ between ESBL carriers and noncarriers. In univariate analysis, ESBL acquisition was associated with male gender, SAPS II, SOFA, chronic kidney disease at admission, duration of mechanical ventilation, need for catecholamine and the ICU LOS. In multivariate analysis, SAPS II at admission was the only risk factor for ESBL acquisition. We confirmed cross-transmission, emanating from the same index patient, in two of the nine patients with ESBL acquisition (0.8%, 2/221). No case of cross-transmission in the same double room was observed. Discussion and conclusion: Prevalence of ESBL colonization in our ICU was 13.2%. Despite the absence single rooms, the incidence of ESBL acquisition was 4.1% and cross-transmission was proven in only two cases, resulting from the same index patient who was not hospitalized in the same double room.

Screening for Intestinal Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae in Critically Ill Patients: Expected Benefits and Evidence-based Controversies

“…The MOSAR investigators confirmed afterwards that the transmissibility of ESBL-E between ICU patients was actually weak, and was even 3 times lower for ESBL-producing E. coli when compared to other ESBL-E (number of secondary cases per index carrier: 0.047 and 0.17, respectively) [17]. These findings corroborate those of several single-center studies based on molecular methods (strain and/or ESBL typing) that reported very low rates of cross-transmission from documented ESBL-E carriers, including in units without single-bed rooms, suggesting other potential sources of acquisition, such as healthcare workers, contaminated environmental reservoirs, or patient transports outside the ICU [18,19].…”

The prevalence of ESBL and AmpC β-lactamases in uropathogenic isolates of Escherichia coli in a tertiary care hospital in Southwest Iran

“…Meanwhile, higher prevalence of ESBL producing E. coli was observed in ICU. The rate of ESBLproducing E.coli in ICUs varies greatly in different parts of the globe ranging from 13.2% in France (22) to as high as 61% in India (18). The prevalence of ESBL producing E.coli among the ICUs in Iran ranges from 11.4% (23) to 70.6% (24), whereas the prevalence rate in our study was 65.8%.…”

ESBL-colonization at ICU admission: impact on subsequent infection, carbapenem-consumption, and outcome

“…20 Recent studies on colonization in ICU patients show rates varying between 2% 21 and up to 56%, 22 and this large range can be explained by different settings and countries, such as the United States and India, as well as different time frames (2001-2005 and 2016). In our cohort, as in most published studies on ESBL-PE colonization, [22][23][24] 22 of 24 ESBL-PE isolates were E. coli.…”