1438. ESBL carriage upon hospital admission: prevalence and risk factors
Session: Poster Abstract Session: Epidemiology of Multiple Drug-Resistant Gram Negative Rods
Saturday, October 20, 2012
Room: SDCC Poster Hall F-H
Posters
  • poster ID week.pdf (262.7 kB)
  • Background:

    Extended spectrum beta-lactamase producing Enterobacteriacea (ESBL-E) are increasing worldwide. In recent years, a shift from infections with Klebsiella ESBL to E. coli ESBL was observed. At Meir Medical Center, we have observed a consistent rise in nosocomial E. coli ESBL blood stream infections despite contact isolation of patients with positive ESBL clinical cultures. The aim of this study was to assess the additive value of surveillance cultures in identifying unknown ESBL carriers.

    Methods:

    We performed universal screening for ESBL of all new admissions, excluding the Pediatric and Obstetric Departments, during one week. Rectal swabs were collected and sent to the Microbiology Laboratory for ESBL identification. Demographic and clinical data were collected for all patients from the hospital electronic data system. Multivariate analysis to identify independent risk factors for ESBL carriage was performed.

    Results: Nine hundred fifty-two new patients were admitted to the hospital from April 4-11, 2011. Five hundred twenty-five (55.14% compliance) were screened for ESBL. Of these 525 patients, 56 (10.6%) were positive for ESBL, 41 (73.2%) samples were E. coli. Most positive patients (76.78%) did not have positive clinical cultures and were not known as previous ESBL carriers. Four independent risk factors for current ESBL carriage were found: nursing home residency OR 2.8 (95% CI: 1.34-5.85), prior hospitalization at another hospital OR 3.0 (95% CI: 1.21-7.41), prior antibiotic treatment OR 3.31 (95% CI: 1.97- 6.59), and prior ESBL carriage OR 4.19 (95% CI: 1.76- 10.01). Over 50% (273) of the screened patients had at least one risk factor. Of these patients, 49/273 (17.9%) were screen positive, compared to only 2.8% (7 of 252) patients with no risk factors

    Conclusion:

    A 10.6% prevalence of ESBL carriers among new admissions to the hospital was found. Targeted screening for high-risk patients would identify most asymptomatic carriers.

    Pnina Shitrit, MD1, Sharon Reisfeld, MD1, Yossi Paitan, phd2, bat Shva Gottesman, md1, Mical Paul3 and Michal Chowers, md1, (1)infectious disease, Meir Medical Center, Kfar Saba, Israel, (2)microbiologic laboratory, Meir medical center, Kfar saba, Israel, (3)Rabin Medical Center, Petach Tikva, Israel

    Disclosures:

    P. Shitrit, None

    S. Reisfeld, None

    Y. Paitan, None

    B. S. Gottesman, None

    M. Paul, None

    M. Chowers, None

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