The incidence of extended-spectrum beta-lactamase producing-enterobacteriacae (ESBL-E) infection is rising worldwide. Pasricha, et al. (2013) aimed to determine the prevalence and nosocomial acquisition rate of ESBL-E as well as the risk factors for ESBL-E carriage and acquisition amongst patients consecutively admitted to 13 internal medicine units at our hospital who were not previously known to be ESBL-E carriers.
The researchers screened all patients admitted or transferred to internal medicine units for ESBL-E on admission and discharge using rectal swabs. Of 1072 patients screened, 51 (4.8%) were carriers of an ESBL-E at admission. Of 473 patients who underwent admission and discharge screening, 21 (4.4%) acquired an ESBL-E. On multivariate analysis, diabetes mellitus without end-organ complications (OR 2.8 [1.1-7.1]), connective tissue disease (OR 7.2 [1.2-44.6], and liver failure (OR 8.4 [1.5-45.4]) were independent risk factors for carriage of an ESBL-E upon admission to hospital (area under the ROC curve, 0.68). Receipt of a first- or second-generation cephalosporin (OR 9.25 [2.2-37.8]), intra-hospital transfer (OR 6.7 [1.7-26.1]), and a hospital stay >21 days (OR 25.1 [4.2-151.7]) were associated with acquisition of an ESBL-E during hospitalization; while admission from home was protective (OR 0.16 [0.06-0.39]) on univariate regression. No risk profile with sufficient accuracy to predict previously unknown carriage on admission or acquisition of ESBL-E could be developed using readily available patient information.
The researcehrs conclude that ESBL-E carriage is endemic amongst internal medicine patients at their institution and they were unable to develop a clinical risk profile to accurately predict ESBL-E carriage amongst these patients. Their research was published in Antimicrobial Resistance and Infection Control.
Reference: Pasricha J, Koessler T, Harbarth S, Schrenzel J, Camus V, Cohen G, Perrier A, Pittet D and Iten A. Carriage of extended-spectrum beta-lactamase-producing enterobacteriacae among internal medicine patients in Switzerland. Antimicrobial Resistance and Infection Control 2013, 2:20 doi:10.1186/2047-2994-2-20