title: Clinical predictive values of extended-spectrum beta-lactamase carriage in patients admitted to medical wards.
abstract: We aimed to reassess, through clinical items, populations at risk for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage at admission to hospital and to assess the risk of further positive clinical culture of ESBL-E among carriers. We performed a 5-month cohort study in a medicine ward of a 500-bed university teaching hospital in the Parisian area of France. All admitted patients were prospectively enrolled for rectal swabbing and clinical data collection, including bacterial infection at admission and during stay. Variables associated with ESBL-E carriage were identified by univariate and multivariate analysis. Five hundred patients were included. The prevalence of ESBL-E was 6.6% (33/500) upon admission. Only previous carriage of multidrug-resistant bacteria (MDRB) was associated with carriage (odds ratio [OR]: 17.7, 95% confidence interval (CI) 5.8-54.2, p < 0.001), yet, the positive predictive value (PPV) was not higher than 50%. When prior MDRB carriage was not considered in the multivariate analysis, only prior antibiotic consumption was found to be associated with carriage at admission (OR: 2.2 [1.1-4.5], p = 0.02). Two patients had ESBL-E infection at admission, yet, no patient became infected with ESBL-E during their stay. The clinical prediction of ESBL carriage at admission in our wards was found to be poorly efficient for assessing the at-risk population.
authors.affiliation: EA3964, Faculté de Médecine Paris Diderot, Paris, France. etienne.ruppe@bch.aphp.fr
authors.forename: E
authors.initials: E
authors.lastname: Ruppé
authors.forename: A
authors.initials: A
authors.lastname: Pitsch
authors.forename: F
authors.initials: F
authors.lastname: Tubach
authors.forename: V
authors.initials: V
authors.lastname: de Lastours
authors.forename: F
authors.initials: F
authors.lastname: Chau
authors.forename: B
authors.initials: B
authors.lastname: Pasquet
authors.forename: J-C
authors.initials: JC
authors.lastname: Lucet
authors.forename: A
authors.initials: A
authors.lastname: Andremont
authors.forename: B
authors.initials: B
authors.lastname: Fantin
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000382:microbiology*; D015331:Cohort Studies; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D001618:beta-Lactamases / Q000378:metabolism*; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; D001618:beta-Lactamases