1599. The Effect of a Hospital-Wide Urine Culture Screening Intervention on the Incidence of Extended-Spectrum Beta-Lactamase (ESBL)-Producing Escherichia coli and Klebsiella Species
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • ESBL poster.pdf (486.0 kB)
  • Background: Optimal infection control strategies for limiting the transmission of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species (ESBL-EK) in the hospital setting remain unclear. The objective of this study was to evaluate the impact of a urine culture screening strategy on the incidence of ESBL-EK.

    Methods: This prospective quasi-experimental study was conducted at two intervention hospitals and one control hospital within a university health system from January 2005 to February 2009. The intervention consisted of screening of all clinical urine cultures with E. coli or Klebsiella spp for ESBL-EK. Patients determined to be colonized or infected with ESBL-EK were placed in a private room with contact precautions. The primary outcome was nosocomial ESBL-EK incidence in non-urinary clinical cultures (cases occurring >48 hours after admission). Changes in monthly ESBL-EK incidence rates were evaluated using mixed effects Poisson regression models, with adjustment for institution-level characteristics (e.g., average length of stay, total admissions).

    Results: The overall clinical incidence of ESBL-EK increased from 1.42 per 10,000 patient-days in the pre-intervention period to 2.16 per 10,000 patient-days in the post-intervention period. The incidence of community-acquired ESBL-EK (cases occurring ≤48 hours after admission) increased nearly three-fold over the study period, from 0.33 cases per 10,000 patient-days in the pre-intervention period to 0.92 cases per 10,000 patient-days in the post-intervention period (P<0.001). On multivariable analysis, the intervention was not significantly associated with a reduction in nosocomial ESBL-EK incidence (incidence rate ratio, 1.38; 95% confidence interval, 0.83-2.31; P=0.21).  

    Conclusion: Universal screening of clinical urine cultures for ESBL-EK did not result in a reduction in nosocomial ESBL-EK incidence rates, most likely due to increases in importation of ESBL-EK cases from the community. Further studies are needed on elucidating optimal infection control interventions to limit spread of ESBL-producing organisms in the hospital setting, including the role of active surveillance screening and effectiveness of contact precautions.

    Jennifer Han, MD, MSCE1, Warren Bilker, PhD2, Irving Nachamkin, DrPH, MPH3, Theoklis Zaoutis, MD, MSCE1,4, Susan Coffin, MD, MPH1,5, Darren R. Linkin, MD, MSCE1,6, Baofeng Hu, MD1, Pam Tolomeo, MPH1, Neil O. Fishman, MD1, Ebbing Lautenbach, MD, MPH, MSCE1 and the CDC Prevention Epicenter Program, (1)University of Pennsylvania School of Medicine, Philadelphia, PA, (2)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (3)Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (4)Division of Infectious Diseases, Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, Philadelphia, PA, The Children's Hospital of Philadelphia, Philadelphia, PA, (5)Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (6)Philadelphia Veterans Affairs Medical Center, Philadelphia, PA

    Disclosures:

    J. Han, None

    W. Bilker, None

    I. Nachamkin, None

    T. Zaoutis, None

    S. Coffin, None

    D. R. Linkin, None

    B. Hu, None

    P. Tolomeo, None

    N. O. Fishman, None

    E. Lautenbach, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.