title: Control of extended-spectrum β-lactamase-producing Enterobacteriaceae nosocomial acquisition in an intensive care unit: A time series regression analysis.
abstract: BACKGROUND
  This study was undertaken to determine the temporal relationship between implementation of different interventions in an intensive care unit (ICU) and control of endemic nosocomial acquisition of extended-spectrum β-lactamase Enterobacteriaceae (ESBLE).
  
  
  METHODS
  This was a prospective observational study with time-series analysis of the monthly incidence of ESBLE and its predictors. In November 2007, after a 14-month baseline period, an intervention consisting of restriction of third-generation cephalosporins (3 GC) and increased use of alcohol-based hand rubs was implemented. In January 2008, an increased health care worker (HCW):patient ratio was also implemented. In March 2010, the ICU was closed, and patients were moved to a clean ICU.
  
  
  RESULTS
  The first intervention resulted in global reduction in 3 GC and increased use of alcohol-based hand rub. A significant change in ESBLE incidence was observed in a full segmented univariate regression analysis (mean change in level, -0.91 ± 0.19; P < .0001). After ICU closure, there was a dramatic reduction in ESBLE acquisition. According to the multivariate model, the ICU closure was the main protective factor. Before ICU closure, an increase in the HCW:patient ratio of 0.1 point tended to be associated with a decreased risk of ESBLE acquisition (relative risk, 0.28; 95% confidence interval, 0.06-1.25; P = .09).
  
  
  CONCLUSIONS
  This study shows that ICU closure was associated with, but not necessarily the reason for, control of ESBLE cross-transmission in a nonoutbreak setting. Environmental ESBE sources may play a role in cross-transmission.
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France; INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Bordeaux, France. Electronic address: alexandre.boyer@chu-bordeaux.fr.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Boyer
authors.affiliation: Institut de Mathématique, Université Bordeaux, Bordeaux, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Couallier
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Clouzeau
authors.affiliation: Service d'Hygiène hospitalière, CHU Bordeaux, Bordeaux, France.
authors.forename: Agnes
authors.initials: A
authors.lastname: Lasheras
authors.affiliation: UMR 5234 CNRS Microbiologie Cellulaire et Moléculaire et Pathogénicité, Université Bordeaux, Bordeaux, France.
authors.forename: Fatima
authors.initials: F
authors.lastname: M'zali
authors.affiliation: UMR 5234 CNRS Microbiologie Cellulaire et Moléculaire et Pathogénicité, Université Bordeaux, Bordeaux, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Kann
authors.affiliation: INSERM, U657 Pharmaco-Epidémiologie et Evaluation de l'Impact des Produits de Santé sur les Populations, Bordeaux, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Rogues
authors.affiliation: Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France; UMR 5234 CNRS Microbiologie Cellulaire et Moléculaire et Pathogénicité, Université Bordeaux, Bordeaux, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Gruson
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D004755:Enterobacteriaceae / Q000201:enzymology* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008875:Middle Aged; D011446:Prospective Studies; D012044:Regression Analysis; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D001618:beta-Lactamases
keywords: Alcohol-based hand rub; Enterobacteriaceae; Extended-spectrum β-lactamase; Intensive care unit; Third-generation cephalosporin; Time series; Workload