Investigators Examine Need for Screening of MDRO-Colonized Patients Transferred From Abroad

While multidrug-resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study Kaspar, et al. (2015) determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk.

This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between Jan. 1, 2012 and Dec. 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA).

A total of 235 transfer patients were screened and analyzed, of which 43 (18 percent) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 percent), with only a single screening revealing MRSA (2 percent); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis the researchers focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p?<?0.001), surgical procedure in a hospital abroad (p?=?0.007), and - on admission to the hospital - active infection (p?=?0.002), antibiotic treatment (p?=?0.014) and presence of skin lesions (p?=?0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization.

The researchers say their data suggest that a large proportion of patients (i.e., 82 percent) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy. Their research was published in Antimicrobial Resistance and Infection Control.

Reference: Kaspar T, Schweiger A, Droz S and Marschall J. Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened? Antimicrobial Resistance and Infection Control 2015, 4:31  doi:10.1186/s13756-015-0071-6