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Carriage of extended-spectrum beta-lactamase-producing enterobacteriacae among internal medicine patients in Switzerland

Janet Pasricha16, Thibaud Koessler2, Stephan Harbarth1*, Jacques Schrenzel3, Véronique Camus1, Gilles Cohen4, Arnaud Perrier2, Didier Pittet15 and Anne Iten12

Author Affiliations

1 Infection Control Program, University of Geneva Hospitals and Medical Faculty, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland

2 Department of General Internal Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

3 Central Laboratory of Bacteriology, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

4 Division of Medico-Economic Analysis, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

5 WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland

6 The Jenner Institute, University of Oxford, Oxford, UK

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Antimicrobial Resistance and Infection Control 2013, 2:20  doi:10.1186/2047-2994-2-20

Published: 12 June 2013

Abstract

Background

The incidence of extended-spectrum beta-lactamase producing-enterobacteriacae (ESBL-E) infection is rising worldwide. We 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.

Findings

We 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 2.87 [1.09-7.08]), connective tissue disease (OR 7.22 [1.17-44.59]), and liver failure (OR 8.39 [1.55-45.45]) 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 [2.22-37.82]), intra-hospital transfer (OR 6.68 [1.71-26.06]), and a hospital stay >21 days (OR 25.17 [4.18-151.68]) were associated with acquisition of an ESBL-E during hospitalisation; whilst 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.

Conclusions

ESBL-E carriage is endemic amongst internal medicine patients at our institution. We were unable to develop a clinical risk profile to accurately predict ESBL-E carriage amongst these patients.

Keywords:
Extended-spectrum beta-lactamase producing enterobacteraciae; Infection control; Antimicrobial resistance