Skip to main content
×
Home
    • Aa
    • Aa

Prospective Evaluation of Colonization with Extended-Spectrum β-Lactamase (ESBL)–Producing Enterobacteriaceae Among Patients at Hospital Admission and of Subsequent Colonization with ESBL-Producing Enterobacteriaceae Among Patients During Hospitalization

  • Reuven Friedmann (a1), David Raveh (a2), Esther Zartzer (a1) (a2), Bernard Rudensky (a3), Ellen Broide (a3), Denise Attias (a3) and Amos M. Yinnon (a2)...
Abstract
Objective.

To determine the rates of and risk factors for carriage and acquisition of extended-spectrum (β-lactamase (ESBL)-producing Enterobacteriaceae during hospitalization.

Design.

Cohort study.

Setting.

Shaare Zedek Medical Center, a 550-bed teaching hospital.

Methods.

During a 5-month period (February 1-June 30, 2004), 167 (8%) of 1,985 newly admitted general medical patients were enrolled in our study. Nasal, oropharyngeal, and rectal swab specimens were obtained at admission and every 2-3 days until hospital discharge or death. Enterobacteriaceae isolates were tested for ESBL, and Staphylococcus aureus isolates were tested for methicillin resistance.

Results.

Of the 167 patients enrolled in our study, 15 (9%) were identified as nasal carriers of methicillin-resistant S. aureus (MRSA) at admission, and 13 (8%) were rectal carriers of ESBL-producing Enterobacteriaceae at admission. Univariate risk factors for rectal carriage of ESBL-producing Enterobacteriaceae included female sex (odds ratio [OR], 11 [95% confidence interval {CI}, 1.4—238]; P < .05), nursing home residence (OR, 6.9 [95% CI, 1.8-27]; P < .01), recent antibiotic treatment (OR, 9.8 [95% CI, 1.7-74]; P < .05), and concomitant nasal carriage of MRSA and/or ESBL-producing Enterobacteriaceae (OR, 5.8 [95% CI, 1.2-26]; P < .01). Multivariate risk factors were female sex and recent antibiotic treatment. During hospitalization, 35 (21%) of 167 patients had acquired rectal carriage of ESBL-producing Enterobacteriaceae (P = .002, for trend analysis). Of the 12 patients who were still in the hospital 2 weeks after admission, 4 (33%) were carriers of ESBL-producing Enterobacteriaceae. Univariate risk factors for acquisition included an age of older than 65 years (P < .005), nursing home residence (OR 2.6, [95% CI, 0.98-2.6]), impaired cognition (OR, 4.8 [95% CI, 1.9-12]), recent antibiotic treatment (OR, 2.7 [95% CI, 0.9-8.3]), respiratory assistance (OR, 4.2 [95% CI, 1.2-14]), and prolonged hospitalization. Multivariate risk factors were an age of older than 65 years and broad-spectrum antibiotic therapy.

Conclusions.

Rectal carriage of ESBL-producing Enterobacteriaceae occurred in 13 (8%) of 167 patients at admission to the medical departments of our hospital and in 4 (33%) of 12 patients still remaining in our hospital after 2 weeks.

Copyright
Corresponding author
Division of Medicine, Shaare Zedek Medical Center, P.O. Box 3235, Jerusalem 91031, Israel(yinnon@szmc.org.il)
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1. DM Livermore . Bacterial resistance: origins, epidemiology, and impact. Clin Infect Dis 2003;36(Suppl 1):S11S23.

, . . ;:–.2. DL Paterson RA Bonomo Extended-spectrum β-lactamases: a clinical update Clin Microbiol Rev 2005 18 657686

3. DM Livermore . Defining an extended-spectrum β-lactamase. Clin Microbiol Infect 2008;14 (Suppl 1):310.

, , , , , . . ;:–.5. E Tallis B Rudensky D Attias D Raveh Y Schlesinger AM Yinnon Invitto activity of cefepime and other broad-spectrum antimicrobials against several groups of gram—negative bacilli and Staphylococcus aureus Diagn Microbiol Infect Dis 1999 35 121126

6. MH Nicolas-Chanoine , V Jarlier ; La Collégiale de Bactériologie-Virologie-Hygiène Hospitalière de l’Assistance Publique, Hôpitaux de Paris, France. Extended-spectrum β-lactamases in long-term-care facilities. Clin Microbiol Infect 2008;14 (Suppl 1):111116.

7. JDD Pitout , KB Laupland . Extended-spectrum β-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis 2008;8:159166.

8. J Rodríguez-Baño , MD Navarro . Extended-spectrum β-lactamases in ambulatory care: a clinical perspective. Clin Microbiol Infect 2008;14 (Suppl 1):104110.

9. CT Moor , SA Roberts , G Simmons , et al.Extended-spectrum β-lactamase (ESBL)-producing Enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand. J Hosp Infect 2008;68:355362.

, , , , . . ;:–.10. A Adler D Raveh B Rudensky AM Yinnon S Benenson Enteric gram-negative bacteremia at the emergency department: risk factors for extended-spectrum β-lactamase and outcome Infect Dis Clin Pract 2008 16 109112

, , , , , . . ;:.11. Y Doi J Adams A O'Keefe Z Quereshi L Ewan DL Paterson Community-acquired extended-spectrum β-lactamase producers, United States Emerg Infect Dis 2007 13 1121

12. R Colodner , W Rock , B Chazan , et al.Risk factors for the development of extended-spectrum β-lactamase-producing bacteria in non-hospitalised patients. Eur J Clin Microbiol Infect Dis 2004;23:163167.

14. D Raveh , L Gratch , AM Yinnon , M Sonnenblick . Demographic and clinical characteristics of patients admitted to medical departments. J Eval Clin Pract 2005;11:3344.

15. M Sonnenblick , D Raveh , L Gratch , AM Yinnon . Clinical and demographic characteristics of elderly patients hospitalised in an internal medicine department in Israel. Int J Clin Pract 2007;61:247254.

, , , , . . ;:–.16. S Benenson AM Yinnon Y Schlesinger B Rudensky D Raveh Optimization of empirical antibiotic selection for suspected Gram-negative bacteraemia in the emergency department Int J Antimicrob Agents 2005 25 398403

, , , , . . ;:–.17. D Raveh D Rudensky Y Schlesinger D Attias AM Yinnon Trends in bacteremias: analysis of 7544 patient-specific bacteremic episodes spanning 11 years (1990-2000) J Hosp Infect 2003 55 196203

, , , . ;:–.19. Z Jerassy AM Yinnon S Mazouz-Cohen et al.Prospective hospital-wide studies of 505 patients with nosocomial bacteraemia in 1997 and 2002 J Hosp Infect 2006 62 230236

20. R Friedmann , R Hamburger , C Shulman , AM Yinnon , D Raveh . Antimicrobial susceptibilities of urinary pathogens in a multidisciplinary long-term care facility. Diagn Microbiol Infect Dis 2003;46:217222.

21. R Henshke , AM Yinnon , B Rudensky , D Attias , D Raveh . Assessment of the clinical significance of production of extended-spectrum-β-lac-tamase (ESBL) by Enterobacteriaceae. Infection 2006;34:6674.

22. D Raveh , E Muallem-Zilca , A Greenberg , Y Wiener-Well , AM Yinnon . Two-phase drug utilization evaluation of cefepime, piperacillin-tazobactam and meropenem. QJM 2006;99:397406.

23. T Drori-Zeides , D Raveh , Y Schlesinger , AM Yinnon . Practical guidelines for vancomycin usage, with prospective drug utilization evaluation. Infect Control Hosp Epidemiol 2000;21:4547.

, , , , , . . ;:–.24. D Raveh Y Levy Y Schlesinger A Greenberg B Rudensky AM Yinnon Longitudinal surveillance of antibiotic use in the hospital QJM 2001 94 141152

27. HF Wertheim , DC Melles , MC Vos , et al.The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751762.

29. A Valverde , TM Coque , MP Sánchez-Moreno , A Rollan , F Baquero , R Canton . Dramatic increase in prevalence of fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae during non-outbreak situations in Spain. J Clin Microbiol 2004;42:47694775.

30. C Buke , L Armand-Lefevre , I Lolom , et al.Epidemiology of multidrug-resistant bacteria in patients with long hospital stay. Infect Control Hosp Epidemiol 2007;28:12551260.

31. IS Martins , CL Pessoa-Silva , SA Nouer , et al.Endemie extended-spectrum β-lactamase-producing Klebsiella pneumoniae at an intensive care unit: risk factors for colonization and infection. Microb Drug Resist 2006;12:5058.

32. F Troché , LM Joly , M Guibert , JF Zazzo . Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective study. Infect Control Hosp Epidemiol 2005;26:161165.

, , , . ;:–.33. S Esposito A Capuano S Noviello et al.Modification of patients' endogenous bacterial flora during hospitalization in a large teaching hospital in Naples J Chemother 2003 15 568573

34. C Peña , M Pujol , A Ricart , et al.Risk factors for faecal carriage of Klebsiella pneumoniae producing extended spectrum β-lactamase (ESBL-KP) in the intensive care unit. J Hosp Infect 1997;35:916.

35. M Tumbarello , M Sanguinetti , E Montuori , et al.Predictors of mortality in blood stream infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae: importance of inadequate antimicrobial treatment. Antimicrob Agents Chemother 2007;51:19871994.

36. E Lautenbach , JB Patel , WB Bilker , PH Edelstein , NO Fishman . Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:11621171.

37. DL Paterson , WC Ko , AV Gottberg , et al.Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum β-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001;39:22062212.

39. RE Warren , G Harvey , R Carr , D Ward , A Doroshenko . Control of infections due to extended-spectrum β-lactamase-producing organisms in hospitals and the community. Clin Microbiol Infect 2008;14(Suppl 1): 124133.

40. P Reddy , M Malczynski , A Obias , et al.Screening for extended-spectrum β-lactamase-producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis 2007;45:846852.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 4 *
Loading metrics...

Abstract views

Total abstract views: 101 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 29th June 2017. This data will be updated every 24 hours.