3 years ago

Cessation of screening for intestinal carriage of ESBL-producing Enterobacteriaceae in a low-endemicity ICU with universal contact precautions

The usefulness of screening for carriage of ESBL-producing Enterobacteriaceae (ESBL-E) with active surveillance cultures (ASC) remains equivocal in low-endemicity ICUs. Our primary objective was to appraise the impact of ceasing ASC on the incidence of ICU-acquired ESBL-E infections in an ICU with universal contact precautions (CP). Patient outcomes and carbapenem consumption were also investigated. Methods A single-ICU, retrospective, uncontrolled before-and-after study including all patients admitted for ≥ 3 days during two consecutive one-year periods with and without ASC. Results A total of 524 and 545 patients were included during the ASC and the no-ASC periods, respectively. Twenty-eight patients (5.3%) from the ASC period were ESBL-E carriers. An ICU-acquired ESBL-E infection (median duration of risk exposure, 4 [2-9] days for both periods) occurred in 1.1% and 1.5% of patients admitted during the ASC and the no-ASC periods (P=0.64), with no inter-period variation in incidence after adjustment on competing risks of death and ICU discharge [standardized hazard ratio (SHR), 2.32, 95% confidence interval (CI), 0.80-6.73, P=0.12]. An admission during the no-ASC period exerted no independent impact on the hazards of ESBL-E infections (adjusted odds ratio, 1.16, 95%CI, 0.38-3.50, P=0.79), in-ICU death (SHR, 1.22, 95%CI, 0.93-1.59, P=0.15) and extended length of stay (SHR for discharge, 0.89, 95%CI, 0.79-1.01, P=0.08). Carbapenem exposure in patients without ESBL-E infection decreased between the ASC and no-ASC periods (75 versus 61 carbapenem-days per 1,000 patient-days, P=0.01). Conclusions In a low-endemicity ICU with universal CP, the withdrawal of routine screening for ESBL-E carriage had no significant effect on the incidence of ICU-acquired ESBL-E infections and patient outcomes. Carbapenem consumption decreased in patients without ESBL-E infection.

Publisher URL: www.sciencedirect.com/science

DOI: S1198743X17304329

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