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. 2013 Apr 26;8(4):e62678.
doi: 10.1371/journal.pone.0062678. Print 2013.

Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae

Christopher F Lowe  1 , Kevin Katz, Allison J McGeer, Matthew P Muller; Toronto ESBL Working Group
Collaborators, Affiliations

Efficacy of admission screening for extended-spectrum beta-lactamase producing Enterobacteriaceae

Christopher F Lowe et al. PLoS One. .

Abstract

Objective: We hypothesized that admission screening for extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) reduces the incidence of hospital-acquired ESBL-E clinical isolates.

Design: Retrospective cohort study.

Setting: 12 hospitals (6 screening and 6 non-screening) in Toronto, Canada.

Patients: All adult inpatients with an ESBL-E positive culture collected from 2005-2009.

Methods: Cases were defined as hospital-onset (HO) or community-onset (CO) if cultures were positive after or before 72 hours. Efficacy of screening in reducing HO-ESBL-E incidence was assessed with a negative binomial model adjusting for study year and CO-ESBL-E incidence. The accuracy of the HO-ESBL-E definition was assessed by re-classifying HO-ESBL-E cases as confirmed nosocomial (negative admission screen), probable nosocomial (no admission screen) or not nosocomial (positive admission screen) using data from the screening hospitals.

Results: There were 2,088 ESBL-E positive patients and incidence of ESBL-E rose from 0.11 to 0.42 per 1,000 inpatient days between 2005 and 2009. CO-ESBL-E incidence was similar at screening and non-screening hospitals but screening hospitals had a lower incidence of HO-ESBL-E in all years. In the negative binomial model, screening was associated with a 49.1% reduction in HO-ESBL-E (p<0.001). A similar reduction was seen in the incidence of HO-ESBL-E bacteremia. When HO-ESBL-E cases were re-classified based on their admission screen result, 46.5% were positive on admission, 32.5% were confirmed as nosocomial and 21.0% were probable nosocomial cases.

Conclusions: Admission screening for ESBL-E is associated with a reduced incidence of HO-ESBL-E. Controlled, prospective studies of admission screening for ESBL-E should be a priority.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Incidence of positive admission screens and percent positivity of rectal screening for ESBL-producing Enterobacteriaceae*.
*Only hospitals R1, R5 and R6 were included as the total number of screens for the remaining hospitals was incomplete.
Figure 2
Figure 2. Incidence of hospital-onset cases of ESBL-producing Enterobacteriaceae in non-screening compared to screening hospitals.
Figure 3
Figure 3. Incidence of community-onset cases of ESBL-producing Enterobacteriaceae in non-screening compared to screening hospitals.
Figure 4
Figure 4. Incidence of hospital-onset cases of ESBL-producing Escherichia coli in non-screening compared to screening hospitals.
Figure 5
Figure 5. Incidence of hospital-onset cases of ESBL-producing Klebsiella pneumoniae in non-screening compared to screening hospitals.
Figure 6
Figure 6. Incidence of hospital-onset ESBL-producing Enterobacteriaceae bacteremia in non-screening compared to screening hospitals.
See this image and copyright information in PMC

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