title: Predicting carriage with extended-spectrum beta-lactamase-producing bacteria at hospital admission: a cross-sectional study.
abstract: The prevalence of patients colonized with extended-spectrum beta-lactamase (ESBL)-producing bacteria increases, especially in long-term-care facilities (LTCFs). Identification of ESBL carriers at hospital admission is relevant for infection control measures and antibiotic therapy for nosocomial infections. We aimed to develop a prediction rule for ESBL carriage at hospital admission for patients admitted from home and LTCFs, and to quantify incidences of nosocomial infections caused by ESBL-producing bacteria. The ESBL-carrier status was determined of patients admitted from LTCFs and from home settings in four hospitals in the Netherlands using perianal swabs obtained within 48 hours of admission. Risk factors for ESBL carriage were assessed. Infections caused by ESBL-producing bacteria were identified retrospectively. Among 1351 patients, 111 (8.2%) were ESBL carriers at admission: 50/579 (8.6%) admitted from LTCFs and 61/772 (7.9%) from home settings (p 0.63). Previous ESBL carriage and previous hospital admission were risk factors for ESBL carriage in multivariable analysis. The area under the curve of the receiver operating characteristic curve of the model was 0.64 (95% CI 0.58-0.71). Presence of ≥1 risk factor (n = 803; 59%) had sensitivity of 72%. Incidences of nosocomial infections caused by ESBL-producing bacteria were 45.5/10,000 and 2.1/10,000 admission days for ESBL carriers and non-carriers, respectively (p <0.05). In conclusion, prevalence of ESBL carriage at hospital admission was 8.2%, and was comparable among patients admitted from LTCF and home. A clinically useful prediction rule for ESBL carriage at admission could not be developed. The absolute incidence of nosocomial infections by ESBL-producing bacteria was low, but higher among patients carrying ESBL-producing bacteria at the time of hospital admission.
authors: Department of Medical Microbiology, Saltro, Utrecht, The Netherlands; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: T N
authors: TN
authors: Platteel
authors: Department of Medical Microbiology, Bronovo Hospital, Den Haag, and Diaconessenhuis, Leiden, The Netherlands.
authors: M A
authors: MA
authors: Leverstein-van Hall
authors: Department of Medical Microbiology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands.
authors: J W
authors: JW
authors: Cohen Stuart
authors: Department of Medical Microbiology, Diakonessenhuis, Utrecht, The Netherlands.
authors: S F T
authors: SF
authors: Thijsen
authors: Department of Medical Microbiology, Rijnstate Hospital, Arnhem The Netherlands.
authors: E M
authors: EM
authors: Mascini
authors: Department of Medical Microbiology and Infection Prevention, Gelre Hospitals, Apeldoorn, The Netherlands.
authors: B C
authors: BC
authors: van Hees
authors: Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: J
authors: J
authors: Scharringa
authors: Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: A C
authors: AC
authors: Fluit
authors: Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
authors: M J M
authors: MJ
authors: Bonten
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000201:enzymology* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis* / Q000382:microbiology*; D001431:Bacteriological Techniques; D002353:Carrier State / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003661:Decision Support Techniques; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010343:Patient Admission; D010502:Perineum / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: Carriage; ESBL; Enterobacteriaceae; hospital admission; risk factors