Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective survey.
OBJECTIVE
To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU).


METHODS
Prospective survey of 2235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E).


METHODS
A surgical ICU in a tertiary-care teaching hospital.


METHODS
All admitted patients.


METHODS
Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers.


RESULTS
The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBLE decreased from 5.5 cases per 1000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage.


CONCLUSIONS
MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.
Troché
Gilles
G
Unité de Reanimation Chirurgicale, Département d'anesthésie-réanimation, Hôpital Antoine Béclère, Clamart, France. gtroche.beclere@invivo.edu
Joly
Luc-Marie
LM
Guibert
Michèle
M
Zazzo
Jean-Fabien
JF
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology*; D005602:France / Q000453:epidemiology; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007902:Length of Stay; D016106:Methicillin Resistance; D016712:Mupirocin / Q000627:therapeutic use; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D013997:Time Factors
D000900:Anti-Bacterial Agents; D016712:Mupirocin