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|Title||The effect of a hospital-wide urine culture screening intervention on the incidence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species.|
|Publication Type||Journal Article|
|Year of Publication||2013|
|Authors||Han JH, Bilker WB, Nachamkin I, Zaoutis TE, Coffin SE, Linkin DR, Hu B, Tolomeo P, Fishman NO, Lautenbach E|
|Journal||Infect Control Hosp Epidemiol|
|Date Published||2013 Nov|
|Keywords||Bacteriuria, beta-Lactamases, Cross Infection, Escherichia coli, Escherichia coli Infections, Humans, Incidence, Infection Control, Klebsiella, Klebsiella Infections, Mass Screening, Urine|
OBJECTIVE: Optimal strategies for limiting the transmission of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp (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.
DESIGN: Prospective quasi-experimental study.
SETTING: Two intervention hospitals and one control hospital within a university health system from 2005 to 2009.
PATIENTS AND INTERVENTION: All clinical urine cultures with E. coli or Klebsiella spp were screened 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 of interest was nosocomial ESBL-EK incidence in nonurinary clinical cultures (cases occurring more than 48 hours after admission). Changes in monthly ESBL-EK incidence rates were evaluated with mixed-effects Poisson regression models, with adjustment for institution-level characteristics (eg, total admissions).
RESULTS: The overall incidence of ESBL-EK increased from 1.42/10,000 patient-days to 2.16/10,000 patient-days during the study period. The incidence of community-acquired ESBL-EK increased nearly 3-fold, from 0.33/10,000 patient-days to 0.92/10,000 patient-days (P < .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 - .21).
CONCLUSIONS: Universal screening of clinical urine cultures for ESBL-EK did not result in a reduction in nosocomial ESBL-EK incidence rates, most likely because of 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.
|Alternate Journal||Infect Control Hosp Epidemiol|
|PubMed Central ID||PMC3981746|
|Grant List||K24 AI080942 / AI / NIAID NIH HHS / United States |
K24 AI080942 / AI / NIAID NIH HHS / United States
R01-CI000389 / CI / NCPDCID CDC HHS / United States
U54-CK000163 / CK / NCEZID CDC HHS / United States
/ / Intramural NIH HHS / United States