1808. Re-evaluation of Hospital Screening and Transmission Control Programs for Extended-Spectrum β-lactamase-Producing Enterobacteriaceae in Toronto
Session: Poster Abstract Session: Resistant Gram-Negative Infections: Epidemiology
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • ESBL Screening Poster.pdf (659.7 kB)
  • Background: Antibiotic resistance in Enterobacteriaceae (E) is recognized as a public health crisis, and hospital outbreaks due to transmission of extended-spectrum β-lactamase-producing (ESBL)-E are frequently reported. Nonetheless, infection control strategies in a hospital setting remain unclear. We compared the incidence of hospital-onset (HO) and community-onset (CO) ESBL-E bacteremia in Toronto hospitals with and without ESBL-E screening/control protocols to assess the potential benefit of these programs.

    Methods: We conducted a multi-center retrospective cohort study comparing the incidence of ESBL-E E. coli and Klebsiella spp. bacteremia from 2010 to 2014 in 6 screening and 6 non-screening Toronto-area hospitals. The primary outcome was the incidence of HO-ESBL-E bacteremia. A first positive blood culture obtained greater than or less than 72 hours post-admission was defined as HO- or CO-ESBL-E bacteremia, respectively.

    Results: A total of 1,191 unique patients were identified, including 1031 cases of E. coli and 160 cases of Klebsiella spp. ESBL-E bacteremia. The overall incidence of ESBL-E bacteremia increased from 0.135 to 0.257 per 1,000 in-patient days (IPD) over the 5-year study period. The incidence of HO-ESBL-E bacteremia was consistently higher in non-screening than screening hospitals, rising from 0.057 (vs. 0.032) in 2010 to 0.071 (vs. 0.051) in 2014 per 1,000 IPD (Figure 1A). The HO/CO ratio was also greater in non-screening vs. screening hospitals (0.976 vs. 0.441). The incidence of CO-ESBL-E bacteremia was consistently higher in screening than non-screening hospitals, rising from 0.097 (vs. 0.083) in 2010 to 0.252 (vs. 0.139) in 2014 per 1,000 IPD (Figure 1B). Among ESBL-E E. coli and Klebsiella spp., antibiotic susceptibility did not change over the study period and was as follows: ciprofloxacin 17.7% and 26.7%, gentamicin 63.7% and 52.1%, and ertapenem 99.1% and 95.8%, respectively.

    Conclusion: The incidence of ESBL-E bacteremia steadily increased from 2010 to 2014. ESBL-E screening/control programs were associated with a persistently lower incidence of HO bacteremia, suggesting that ESBL-E screening may prevent nosocomial transmission. Cost-benefit analyses of such programs should be conducted.

    Tiffany Chan, MD, Internal Medicine, University of Toronto, Toronto, ON, Canada, Danny K. Chen, MD, FRCPC, Mackenzie Richmond Hill Hospital, Richmond Hill, ON, Canada, Susy Hota, MD, MSc, FRCPC, Infection Prevention and Control, University of Toronto, Toronto, ON, Canada, Kevin Katz, MD, CM, MSc, FRCPC, Department of Infection Control, North York General Hospital, Toronto, ON, Canada, Michael D. Lingley, MD, FRCPC, Southlake Regional Health Centre, Aurora, ON, Canada, Reena Lovinsky, MD, FRCPC, General Division, Scarborough Hospital, Scarborough, ON, Canada, Matthew P. Muller, MD, PhD, FRCPC, Medicine, St.Michael's Hospital, Toronto, ON, Canada, Vydia Nankoosingh, MLT, CIC, Infection Prevention and Control, The Scarborough Hospital, Scarborough, ON, Canada, Jeff Powis, MD, MSc, FRCPC, Toronto East General Hospital, Toronto, ON, Canada, Daniel Ricciuto, MD, FRCPC, Infection Prevention and Control, Lakeridge Hospital, Oshawa, ON, Canada, Alicia Sarabia, MD, FRCPC, Laboratory Medicine, TIBDN Influenza Study Group, Mississauga, ON, Canada, Andrew E. Simor, MD, FRCPC, FACP, FIDSA, FSHEA, Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Mary E. Vearncombe, MD, FRCPC, Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, ON, Canada, Allison Mcgeer, MD, MSc, FRCPC, FSHEA, Infection Control, University of Toronto, Toronto, ON, Canada and Andrea V. Page, MD, MSc, FRCPC, University of Toronto, Toronto, ON, Canada

    Disclosures:

    T. Chan, None

    D. K. Chen, None

    S. Hota, None

    K. Katz, None

    M. D. Lingley, None

    R. Lovinsky, None

    M. P. Muller, None

    V. Nankoosingh, None

    J. Powis, None

    D. Ricciuto, None

    A. Sarabia, None

    A. E. Simor, None

    M. E. Vearncombe, None

    A. Mcgeer, None

    A. V. Page, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.