title: Universal versus targeted additional contact precautions for multidrug-resistant organism carriage for patients admitted to an intensive care unit.
abstract: BACKGROUND
  Although additional contact precautions (ACPs) are routinely used to reduce cross-transmission of multidrug-resistant organisms (MDROs), the relevance of isolation precautions remains debated. We hypothesized that the collection of recognized risk factors for MDRO carriage on intensive care unit (ICU) admission might be helpful to target ACPs without increasing MDRO acquisition during ICU stays, compared with universal ACPs.
  
  
  METHODS
  This is a sequential single-center observational study performed in consecutive patients admitted to a French medical and surgical ICU. During the first 6-month period, screening for MDRO carriage and ACPs were performed in all patients. During the second 6-month period, screening was maintained, but ACP use was guided by the presence of at least 1 defined risk factor for MDRO.
  
  
  RESULTS
  During both periods, 33 (10%) and 30 (10%) among 327 and 297 admissions were, respectively, associated with a positive admission MDRO carriage. During both periods, a second screening was performed in 147 (45%) and 127 (43%) patients. Altogether, the rate of acquired MDRO (positive screening or clinical specimen) was similar during both periods (10% [n = 15] and 11.8% [n = 15], respectively; P = .66).
  
  
  CONCLUSIONS
  The results of our study contribute to support the safety of an isolation-targeted screening policy on ICU admission compared with universal screening and isolation regarding the rate of ICU-acquired MDRO colonization or infection.
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France. Electronic address: michel.djibre@tnn.aphp.fr.
authors.forename: Michel
authors.initials: M
authors.lastname: Djibré
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Samuel
authors.initials: S
authors.lastname: Fedun
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Le Guen
authors.affiliation: Service de Bactériologie-Hygiène, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Univ, Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Vimont
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Univ, Paris, France.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hafiani
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Fulgencio
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.affiliation: Service de Maladies Infectieuses et Tropicales, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Denis
authors.affiliation: Unité de Réanimation et USC médico-chirurgicale, Hôpital Tenon des Assistance Publique-Hôpitaux de Paris, Paris, France; Sorbonne Universités, UPMC Univ, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Fartoukh
mesh_terms: D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000635:transmission; D002353:Carrier State / Q000175:diagnosis / Q000382:microbiology*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005602:France; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged
keywords: Acquisition; Infection; Isolation; Screening