title: Assessment of five screening strategies for optimal detection of carriers of third-generation cephalosporin-resistant Enterobacteriaceae in intensive care units using daily sampling.
abstract: There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of MDRE detection among the 93 patients (62% vs. 70%). In contrast, screening at admission and discharge, screening at admission and weekly thereafter, and screening at admission and weekly thereafter and at discharge significantly increased MDRE detection (77%, p 0.02; 76%, p 0.01; 86%, p<0.001, respectively). The difference in MDRE detection between these strategies relies essentially on the levels of detection of patients with HL-CASE producers. The most reasonable strategy would be to collect two samples, one at admission and one at discharge, which would detect 87.5% of the ESBL strains, 67.3% of the HL-CASE strains and 77.4% of all MDRE strains. This study should facilitate decision-making concerning the most suitable screening policy for MDRE detection in a given ICU setting.
authors.affiliation: Service de Microbiologie, AP-HP Hôpital Européen Georges Pompidou, Paris Cedex 15, France.
authors.forename: P
authors.initials: P
authors.lastname: Grohs
authors.forename: I
authors.initials: I
authors.lastname: Podglajen
authors.forename: E
authors.initials: E
authors.lastname: Guerot
authors.forename: F
authors.initials: F
authors.lastname: Bellenfant
authors.forename: A
authors.initials: A
authors.lastname: Caumont-Prim
authors.forename: G
authors.initials: G
authors.lastname: Kac
authors.forename: B
authors.initials: B
authors.lastname: Tillecovidin
authors.forename: E
authors.initials: E
authors.lastname: Carbonnelle
authors.forename: G
authors.initials: G
authors.lastname: Chatellier
authors.forename: G
authors.initials: G
authors.lastname: Meyer
authors.forename: J Y
authors.initials: JY
authors.lastname: Fagon
authors.forename: L
authors.initials: L
authors.lastname: Gutmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001431:Bacteriological Techniques; D002353:Carrier State / Q000175:diagnosis* / Q000382:microbiology; D002511:Cephalosporins / Q000494:pharmacology*; D003422:Critical Care / Q000379:methods; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000382:microbiology; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening / Q000379:methods; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins
keywords: cephalosporinase; extended-spectrum beta-lactamase; intensive care units; multidrug-resistant Enterobacteriaceae; screening strategies