The Effect of a Hospital-Wide Urine Culture Screening Intervention on the Incidence of Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella Species.
Infect Control Hosp Epidemiol. 2013 Nov;34(11):1160-1166
Authors: Han JH, Bilker WB, Nachamkin I, Zaoutis TE, Coffin SE, Linkin DR, Hu B, Tolomeo P, Fishman NO, Lautenbach E
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 ([Formula: see text]). 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]; [Formula: see text]). 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.
PMID: 24113599 [PubMed - as supplied by publisher]