Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres

Abstract

Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR=1.34; 95% CI, 1.12, 1.6), history of colonization with ESBL-PE (OR=2.97; 95% CI, 1.99, 4.43), unconsciousness on admission (OR=2.59; 95% CI, 1.55, 4.34), surgery or invasive procedure in the past year (OR=1.49; 95% CI, 1.2, 1.86) and antibiotic treatment in the past month (OR=1.80; 95% CI, 1.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.

Outcome of Early Neurological Rehabilitation Patients Colonized with Extended-Spectrum Beta-Lactamase (ESBL) Producing Bacteria

“…In the present study, there was a rate of 23.0% (148/643) ESBL carriers among neurological early rehabilitation patients what comes close to the rate of previously published 26.0% [3]. However, it has to be pointed out that the present study had a retrospective design and not all patients admitted to rehabilitation have been screened for gram negative multidrug-resistant bacteria.…”

“…Up to 26.0% of patients admitted to rehabilitation may be colonized by ESBL producing bacteria [3]. In neurological early rehabilitation colonization rates of 11.2% in a retrospective study have been published [2].…”

“…Appallingly, 3.5% of healthcare personnel and 9% of family members of rehabilitation patients who were carriers of ESBL-PE were also found to be colonized [4]. Risk factors of ESBL-PE colonization are recent stay in acutecare hospital for over two weeks, history of ESBL colonization, unconsciousness on admission, surgery during the last year, and antibiotic treatment during the last month [3]. Other multidrug-resistant gram negative bacteria like Proteus mirabilis (ESBL-PM) also cause problems in rehabilitation [5].…”

“…While MRSA prevalence on admission was 11.4%, multidrug-resistant gram negative germs (ESBL) were observed in 11.8% of early rehabilitation cases [2]. A recent prospective study found an ESBL Enterobacteriaceae (ESBL-PE) prevalence of 26.0% [3]. Appallingly, 3.5% of healthcare personnel and 9% of family members of rehabilitation patients who were carriers of ESBL-PE were also found to be colonized [4].…”

“…A recent prospective study found an ESBL Enterobacteriaceae (ESBL-PE) prevalence of 26.0% [3]. Appallingly, 3.5% of healthcare personnel and 9% of family members of rehabilitation patients who were carriers of ESBL-PE were also found to be colonized [4]. Risk factors of ESBL-PE colonization are recent stay in acutecare hospital for over two weeks, history of ESBL colonization, unconsciousness on admission, surgery during the last year, and antibiotic treatment during the last month [3].…”