title: Predictors of use of infection control precautions for multiresistant gram-negative bacilli in Australian hospitals: analysis of a national survey.
abstract: BACKGROUND
  Despite the global expansion of extended spectrum β-lactamase-harboring Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE), only limited research on the infection control management of patients with these organisms is available.
  
  
  METHODS
  We present a national survey of infection control practices amongst adult acute-care hospitals in Australia, for ESBL-E, CRE, and the emerging threat of patients with overseas health care contact.
  
  
  RESULTS
  In total, 97 health services responded, representing 9% of all eligible hospitals. The proportion of hospitals that reported use of contact precautions (CP) was 96% (93 out of 97) for ESBL-E, 81% (79 out of 97) for CRE, and 72% (48 out of 67) for patients transferred from an international hospital. For ESBL-E hospitals frequently employed risk-stratification to limit the use of CP (40 out of 97; 41%). On multivariate analysis predictors of a strategy to limit use of CP for ESBL-E were government funding (odds ratio, 4.8; P = .003) and a metropolitan location (odds ratio, 3.2; P = .014); predictors of any use of CP for CRE were location in an Australian state with a specific legislation on CRE (P = .030) and the presence of a written policy on CRE (P = .011).
  
  
  CONCLUSIONS
  Infection control management of multiresistant gram-negative bacilli varied considerably across the Australian hospitals surveyed. A lower rate of reported CP use for CRE than for ESBL-E was unexpected and indicates a vulnerability in some Australian hospitals. Multivariate analysis revealed various drivers influencing infection control practice in Australia.
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Australia. Electronic address: benrogers@uq.edu.au.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Rogers
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Australia.
authors.forename: Sally M
authors.initials: SM
authors.lastname: Havers
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Australia.
authors.forename: Tiffany M
authors.initials: TM
authors.lastname: Harris-Brown
authors.affiliation: The University of Queensland, UQ Centre for Clinical Research, Herston, Brisbane, Australia.
authors.forename: David L
authors.initials: DL
authors.lastname: Paterson
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001315:Australia; D015780:Carbapenems / Q000627:therapeutic use; D003428:Cross Infection / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D001618:beta-Lactamases
keywords: Bacterial infection; Carbapenemase; Cephalosporin resistance; Patient isolation; β-lactamase