title: 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.
authors.affiliation: Division of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: E
authors.initials: E
authors.lastname: Bilavsky
authors.forename: E
authors.initials: E
authors.lastname: Temkin
authors.forename: Y
authors.initials: Y
authors.lastname: Lerman
authors.forename: A
authors.initials: A
authors.lastname: Rabinovich
authors.forename: J
authors.initials: J
authors.lastname: Salomon
authors.forename: C
authors.initials: C
authors.lastname: Lawrence
authors.forename: A
authors.initials: A
authors.lastname: Rossini
authors.forename: A
authors.initials: A
authors.lastname: Salvia
authors.forename: J V
authors.initials: JV
authors.lastname: Samso
authors.forename: J
authors.initials: J
authors.lastname: Fierro
authors.forename: M
authors.initials: M
authors.lastname: Paul
authors.forename: J
authors.initials: J
authors.lastname: Hart
authors.forename: M
authors.initials: M
authors.lastname: Gniadkowski
authors.forename: M
authors.initials: M
authors.lastname: Hochman
authors.forename: M
authors.initials: M
authors.lastname: Kazma
authors.forename: A
authors.initials: A
authors.lastname: Klein
authors.forename: A
authors.initials: A
authors.lastname: Adler
authors.forename: M J
authors.initials: MJ
authors.lastname: Schwaber
authors.forename: Y
authors.initials: Y
authors.lastname: Carmeli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques; D004755:Enterobacteriaceae / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000382:microbiology; D012047:Rehabilitation Centers; D012307:Risk Factors; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: ESBL; Extended-Spectrum beta-Lactamase; enterobacteriaceae; long-term care facilities; rehabilitation