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

Published online by Cambridge University Press:  21 February 2019

Aurélien Emmanuel Martinez Open the ORCID record for Aurélien Emmanuel Martinez [Opens in a new window] ,
Andreas Widmer ,
Reno Frei ,
Hans Pargger ,
Daniel Tuchscherer ,
Stephan Marsch ,
Adrian Egli  and
Sarah Tschudin-Sutter
Aurélien Emmanuel Martinez
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Andreas Widmer
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
Reno Frei
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Clinical Microbiology, University Hospital Basel, Basel, Switzerland
Hans Pargger
Affiliation:
Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland
Daniel Tuchscherer
Affiliation:
Department of Anesthesiology, Operative Intensive Care, Preclinical Emergency Medicine and Pain Management, University Hospital Basel, Basel, Switzerland
Stephan Marsch
Affiliation:
Department of Intensive Care Medicine, University Hospital of Basel, Basel, Switzerland
Adrian Egli
Affiliation:
Clinical Microbiology, University Hospital Basel, Basel, Switzerland Division of Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
Sarah Tschudin-Sutter*
Affiliation:
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland Department of Clinical Research, University Hospital Basel, University Basel, Basel, Switzerland
*
Author for correspondence: Sarah Tschudin-Sutter, Email: [email protected]
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Abstract

Objective:

To determine whether colonization with extended-spectrum β-lactamase–producing Enterobacteriaceae (ESBL-PE) predicts the risk for subsequent infection and impacts carbapenem-consumption and outcome in intensive care unit (ICU) patients.

Design:

Prospective cohort study.

Setting:

The 2 ICUs in the University Hospital Basel in Switzerland.

Patients:

All patients admitted to the 2 ICUs providing mechanical ventilation and an expected ICU stay >48 hours.

Methods:

Patients were routinely screened for ESBL-PE carriage by rectal swab on admission. Competing risk regression analyses were applied to calculate hazard ratios (HRs) for infection with ESBL-PE and mortality. Length of hospital stay, length of ICU stay, and duration of carbapenem exposure were compared using the Mann-Whitney U test.

Results:

Among 302 patients, 24 (8.0%) were colonized with ESBL-PE on ICU admission. Infections with ESBL-PE occurred in 4 patients, of whom 3 (75%) were identified as ESBL-PE colonized on admission. ESBL-PE colonization on admission was associated with subsequent ESBL-PE infection (hazard ratio [HR], 25.52; 95% confidence interval [CI], 2.40–271.41; P = .007) and exposure to carbapenems (HR, 2.42; 95% CI, 1.01–5.79; P = .047), whereas duration of carbapenem exposure did not differ in relation to ESBL-PE colonization (median, 7 days [IQR, 3–8 days] vs median, 6 days [IQR 3–9 days]; P = 0.983). Patients colonized with ESBL-PE were not at increased risk for death overall (HR, 1.00; 95% CI, 0.44–2.30; P = .993) or death attributable to infection (HR, 1.20; 95% CI, 0.28–5.11; P = .808).

Conclusions:

Screening strategies for detection of ESBL-PE colonization on ICU admission may allow the identification of patients at highest risk for ESBL-PE infection and the correct allocation of empiric carbapenem treatment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 40 , Issue 4 , April 2019 , pp. 408 - 413
Copyright
© 2019 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: Preliminary results of this study were presented as a poster and as an abstract at the 27th ECCMID European Congress of Clinical Microbiology and Infectious Diseases on April 24, 2017, in Vienna, Austria.

References

Paterson, DL, Bonomo, RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657–686.CrossRefGoogle ScholarPubMed
Bradford, PA. Extended-spectrum β-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat. Clin Microbiol Rev 2001;14:933–951.CrossRefGoogle ScholarPubMed
Candevir Ulu, A, Kurtaran, B, Inal, AS, et al. Risk factors of carbapenem-resistant Klebsiella pneumoniae infection: a serious threat in ICUs. Med Sci Monit 2015;21:219–224.Google ScholarPubMed
Chelazzi, C, Pettini, E, Villa, G, De Gaudio, AR. Epidemiology, associated factors and outcomes of ICU-acquired infections caused by gram-negative bacteria in critically ill patients: an observational, retrospective study. BMC Anesthesiol 2015;15:125.CrossRefGoogle ScholarPubMed
Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed
Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000;21:510–515.CrossRefGoogle ScholarPubMed
Johnson, MT, Reichley, R, Hoppe-Bauer, J, Dunne, WM, Micek, S, Kollef, M. Impact of previous antibiotic therapy on outcome of gram-negative severe sepsis. Crit Care Med 2011;39:1859–1865.CrossRefGoogle ScholarPubMed
Pakyz, AL, Oinonen, M, Polk, RE. Relationship of carbapenem restriction in 22 university teaching hospitals to carbapenem use and carbapenem-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother 2009;53:1983–1986.CrossRefGoogle ScholarPubMed
Kritsotakis, EI, Tsioutis, C, Roumbelaki, M, Christidou, A, Gikas, A. Antibiotic use and the risk of carbapenem-resistant extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae infection in hospitalized patients: results of a double case-control study. J Antimicrob Chemother 2011;66:1383–1391.CrossRefGoogle ScholarPubMed
Biehl, LM, Schmidt-Hieber, M, Liss, B, Cornely, OA, Vehreschild, MJGT. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients—review of the literature from a clinical perspective. Crit Rev Microbiol 2016;42:1–16.CrossRefGoogle ScholarPubMed
Cornejo-Juárez, P, Suárez-Cuenca, JA, Volkow-Fernández, P, et al. Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies. Support Care Cancer 2016;24:253–259.CrossRefGoogle ScholarPubMed
Vehreschild, MJGT, Hamprecht, A, Peterson, L, et al. A multicentre cohort study on colonization and infection with ESBL-producing Enterobacteriaceae in high-risk patients with haematological malignancies. J Antimicrob Chemother 2014;69:3387–3392.CrossRefGoogle ScholarPubMed
Ebrahimi, F, Mózes, J, Monostori, J, et al. Comparison of the faecal colonization rates with extended-spectrum beta-lactamase producing enterobacteria among patients in different wards, outpatients and screened medical students. Microbiol Immunol 2016;60:285–294.CrossRefGoogle Scholar
Bassetti, M, De Waele, JJ, Eggimann, P, et al. Preventive and therapeutic strategies in critically ill patients with highly resistant bacteria. Intens Care Med 2015;41:776–795.CrossRefGoogle ScholarPubMed
Hinic, V, Ziegler, J, Straub, C, Goldenberger, D, Frei, R. Extended-spectrum beta-lactamase (ESBL) detection directly from urine samples with the rapid isothermal amplification-based eazyplex(R) SuperBug CRE assay: proof of concept. J Microbiol Methods 2015;119:203–205.CrossRefGoogle ScholarPubMed
Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.CrossRefGoogle ScholarPubMed
National Healthcare Safety Network (NHSN) Patient Safety Component Manual. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Published 2018. Accessed January 15, 2019.Google Scholar
Fine, JP, Gray, RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999;94:496–509.CrossRefGoogle Scholar
Coviello, V, Boggess, M. Cumulative incidence estimation in the presence of competing risks. Stata J 2004;4:103–112.CrossRefGoogle Scholar
Pires, J, Kuenzli, E, Hauser, C, et al. Intestinal colonisation with extended-spectrum cephalosporin-resistant Enterobacteriaceae in different populations in Switzerland: prevalence, risk factors and molecular features. J Glob Antimicrob Resist 2017;12:17–19.CrossRefGoogle ScholarPubMed
Harris, AD, McGregor, JC, Johnson, JA, et al. Risk factors for colonization with extended-spectrum beta-lactamase-producing bacteria and intensive care unit admission. Emerg Infect Dis 2007;13:1144–1149.CrossRefGoogle ScholarPubMed
Mulki, SS, Ramamurthy, K, Bhat, S. Fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care unit patients. Indian J Crit Care Med 2017;21:525–527.CrossRefGoogle ScholarPubMed
Pilmis, B, Cattoir, V, Lecointe, D, et al. Carriage of ESBL-producing Enterobacteriaceae in French hospitals: the PORTABLSE study. J Hosp Infect 2018;98:247–252.CrossRefGoogle ScholarPubMed
Repesse, X, Artiguenave, M, Paktoris-Papine, S, et al. Epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae in an intensive care unit with no single rooms. Ann Intensive Care 2017;7:73.CrossRefGoogle Scholar
Osthoff, M, McGuinness, SL, Wagen, AZ, Eisen, DP. Urinary tract infections due to extended-spectrum beta-lactamase-producing gram-negative bacteria: identification of risk factors and outcome predictors in an Australian tertiary referral hospital. Int J Infect Dis 2015;34:79–83.CrossRefGoogle Scholar
Maslikowska, JA, Walker, SA, Elligsen, M, et al. Impact of infection with extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella species on outcome and hospitalization costs. J Hosp Infect 2016;92:33–41.CrossRefGoogle ScholarPubMed
Rodriguez-Bano, J, Picon, E, Gijon, P, et al. Community-onset bacteremia due to extended-spectrum beta-lactamase-producing Escherichia coli: risk factors and prognosis. Clin Infect Dis 2010;50:40–48.CrossRefGoogle ScholarPubMed
Barbier, F, Pommier, C, Essaied, W, et al. Colonization and infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in ICU patients: what impact on outcomes and carbapenem exposure? J Antimicrob Chemother 2016;71:1088–1097.CrossRefGoogle ScholarPubMed
Leistner, R, Bloch, A, Sakellariou, C, Gastmeier, P, Schwab, F. Costs and length of stay associated with extended-spectrum beta-lactamase production in cases of Escherichia coli bloodstream infection. J Glob Antimicrob Resist 2014;2:107–109.CrossRefGoogle ScholarPubMed
Tumbarello, M, Spanu, T, Di Bidino, R, et al. Costs of bloodstream infections caused by Escherichia coli and influence of extended-spectrum-beta-lactamase production and inadequate initial antibiotic therapy. Antimicrob Agents Chemother 2010;54:4085–4091.CrossRefGoogle ScholarPubMed
Harris, PN, Yin, M, Jureen, R, et al. Comparable outcomes for beta-lactam/beta-lactamase inhibitor combinations and carbapenems in definitive treatment of bloodstream infections caused by cefotaxime-resistant Escherichia coli or Klebsiella pneumoniae. Antimicrob Resist Infect Control 2015;4:14.CrossRefGoogle ScholarPubMed
Ng, TM, Khong, WX, Harris, PN, et al. Empiric piperacillin-tazobactam versus carbapenems in the treatment of bacteraemia due to extended-spectrum beta-lactamase-producing Enterobacteriaceae. PLoS One 2016;11:e0153696.CrossRefGoogle ScholarPubMed
Liss, BJ, Vehreschild, JJ, Cornely, OA, et al. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection 2012;40:613–619.CrossRefGoogle ScholarPubMed
Cheikh, A, Belefquih, B, Chajai, Y, Cheikhaoui, Y, El Hassani, A, Benouda, A. Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) colonization as a risk factor for developing ESBL infections in pediatric cardiac surgery patients: “retrospective cohort study”. BMC Infect Dis 2017;17:237.CrossRefGoogle ScholarPubMed
Cornejo-Juarez, P, Suarez-Cuenca, JA, Volkow-Fernandez, P, et al. Fecal ESBL Escherichia coli carriage as a risk factor for bacteremia in patients with hematological malignancies. Support Care Cancer 2016;24:253–259.CrossRefGoogle ScholarPubMed
Grohs, P, Podglajen, I, Guerot, E, et al. Assessment of five screening strategies for optimal detection of carriers of third-generation cephalosporin-resistant Enterobacteriaceae in intensive care units using daily sampling. Clin Microbiol Infect 2014;20:O879–O886.CrossRefGoogle ScholarPubMed
van Prehn, J, Kaiser, AM, van der Werff, SD, van Mansfeld, R, Vandenbroucke-Grauls, C. Colonization sites in carriers of ESBL-producing gram-negative bacteria. Antimicrob Resist Infect Control 2018;7:52.CrossRefGoogle ScholarPubMed