The effect of a hospital-wide urine culture screening intervention on the incidence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species.

TitleThe effect of a hospital-wide urine culture screening intervention on the incidence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species.
Publication TypeJournal Article
Year of Publication2013
AuthorsHan JH, Bilker WB, Nachamkin I, Zaoutis TE, Coffin SE, Linkin DR, Hu B, Tolomeo P, Fishman NO, Lautenbach E
JournalInfect Control Hosp Epidemiol
Volume34
Issue11
Pagination1160-6
Date Published2013 Nov
ISSN1559-6834
KeywordsBacteriuria, beta-Lactamases, Cross Infection, Escherichia coli, Escherichia coli Infections, Humans, Incidence, Infection Control, Klebsiella, Klebsiella Infections, Mass Screening, Urine
Abstract

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.

DOI10.1086/673453
Alternate JournalInfect Control Hosp Epidemiol
PubMed ID24113599
PubMed Central IDPMC3981746
Grant ListK24 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