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Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit

Background: Identification of hospitalized patients with enteric multidrug-resistant organism (MDRO) carriage, combined with implementation of targeted infection control interventions, may help reduce MDRO transmission. However, the optimal surveillance approach has not been defined. We sought to de...

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Autores principales: Sansom, Sarah, Lin, Michael, Fukuda, Christine, Shimasaki, Teppei, Dangana, Thelma, Moore, Nicholas, Yelin, Rachel, Rhee, Yoona, Tabith, Lina, Sheng, Jianrong, Cornejo Cisneros, Enrique, Murray, John, Chang, Kyle, Lolans, Karen, Ariston, Michelle, Rotunno, William, Ramos, Hazel, Li, Haiying, Aboushaala, Khaled, Iwai, Naomi, Bassis, Christine, Young, Vincent, Hayden, Mary
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9551442/
http://dx.doi.org/10.1017/ash.2021.51
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author Sansom, Sarah
Lin, Michael
Fukuda, Christine
Shimasaki, Teppei
Dangana, Thelma
Moore, Nicholas
Yelin, Rachel
Rhee, Yoona
Tabith, Lina
Sheng, Jianrong
Cornejo Cisneros, Enrique
Murray, John
Chang, Kyle
Lolans, Karen
Ariston, Michelle
Rotunno, William
Ramos, Hazel
Li, Haiying
Aboushaala, Khaled
Iwai, Naomi
Bassis, Christine
Young, Vincent
Hayden, Mary
author_facet Sansom, Sarah
Lin, Michael
Fukuda, Christine
Shimasaki, Teppei
Dangana, Thelma
Moore, Nicholas
Yelin, Rachel
Rhee, Yoona
Tabith, Lina
Sheng, Jianrong
Cornejo Cisneros, Enrique
Murray, John
Chang, Kyle
Lolans, Karen
Ariston, Michelle
Rotunno, William
Ramos, Hazel
Li, Haiying
Aboushaala, Khaled
Iwai, Naomi
Bassis, Christine
Young, Vincent
Hayden, Mary
author_sort Sansom, Sarah
collection PubMed
description Background: Identification of hospitalized patients with enteric multidrug-resistant organism (MDRO) carriage, combined with implementation of targeted infection control interventions, may help reduce MDRO transmission. However, the optimal surveillance approach has not been defined. We sought to determine whether daily serial rectal surveillance for MDROs detects more incident cases (acquisition) of MDRO colonization in medical intensive care unit (MICU) patients than admission and discharge surveillance alone. Methods: Prospective longitudinal observational single-center study from January 11, 2017, to January 11, 2018. Inclusion criteria were ≥3 consecutive MICU days and ≥2 rectal or stool swabs per MICU admission. Daily rectal or stool swabs were collected from patients and cultured for MDROs, including vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacterales (CRE), third-generation cephalosporin-resistant Enterobacterales (3GCR), and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) (as a subset of 3GCR). MDRO detection at any time during the MICU stay was used to calculate prevalent colonization. Incident colonization (acquisition) was defined as new detection of an MDRO after at least 1 prior negative swab. We then determined the proportion of prevalent and incident cases detected by daily testing that were also detected when only first swabs (admission) and last swabs (discharge) were tested. Data were analyzed using SAS version 9.4 software. Results: In total, 939 MICU stays of 842 patients were analyzed. Patient characteristics were median age 64 years (interquartile range [IQR], 51–74), median MICU length of stay 5 days (IQR, 3–8), median number of samples per admission 3 (IQR, 2–5), and median Charlson index 4 (IQR, 2–7). Prevalent colonization with any MDRO was detected by daily swabbing in 401 stays (42.7%). Compared to daily serial swabbing, an admission- and discharge-only approach detected ≥86% of MDRO cases (ie, overall prevalent MDRO colonization). Detection of incident MDRO colonization by an admission- or discharge-only approach would have detected fewer cases than daily swabbing (Figure 1); ≥34% of total MDRO acquisitions would have been missed. Conclusions: Testing patients upon admission and discharge to an MICU may fail to detect MDRO acquisition in more than one-third of patients, thereby reducing the effectiveness of MDRO control programs that are targeted against known MDRO carriers. The poor performance of a single discharge swab may be due to intermittent or low-level MDRO shedding, inadequate sampling, or transient MDRO colonization. Additional research is needed to determine the optimal surveillance approach of enteric MDRO carriage. Funding: No Disclosures: None
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spelling pubmed-95514422022-10-12 Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit Sansom, Sarah Lin, Michael Fukuda, Christine Shimasaki, Teppei Dangana, Thelma Moore, Nicholas Yelin, Rachel Rhee, Yoona Tabith, Lina Sheng, Jianrong Cornejo Cisneros, Enrique Murray, John Chang, Kyle Lolans, Karen Ariston, Michelle Rotunno, William Ramos, Hazel Li, Haiying Aboushaala, Khaled Iwai, Naomi Bassis, Christine Young, Vincent Hayden, Mary Antimicrob Steward Healthc Epidemiol Surveillance/Public Health Background: Identification of hospitalized patients with enteric multidrug-resistant organism (MDRO) carriage, combined with implementation of targeted infection control interventions, may help reduce MDRO transmission. However, the optimal surveillance approach has not been defined. We sought to determine whether daily serial rectal surveillance for MDROs detects more incident cases (acquisition) of MDRO colonization in medical intensive care unit (MICU) patients than admission and discharge surveillance alone. Methods: Prospective longitudinal observational single-center study from January 11, 2017, to January 11, 2018. Inclusion criteria were ≥3 consecutive MICU days and ≥2 rectal or stool swabs per MICU admission. Daily rectal or stool swabs were collected from patients and cultured for MDROs, including vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacterales (CRE), third-generation cephalosporin-resistant Enterobacterales (3GCR), and extended-spectrum β-lactamase–producing Enterobacterales (ESBL-E) (as a subset of 3GCR). MDRO detection at any time during the MICU stay was used to calculate prevalent colonization. Incident colonization (acquisition) was defined as new detection of an MDRO after at least 1 prior negative swab. We then determined the proportion of prevalent and incident cases detected by daily testing that were also detected when only first swabs (admission) and last swabs (discharge) were tested. Data were analyzed using SAS version 9.4 software. Results: In total, 939 MICU stays of 842 patients were analyzed. Patient characteristics were median age 64 years (interquartile range [IQR], 51–74), median MICU length of stay 5 days (IQR, 3–8), median number of samples per admission 3 (IQR, 2–5), and median Charlson index 4 (IQR, 2–7). Prevalent colonization with any MDRO was detected by daily swabbing in 401 stays (42.7%). Compared to daily serial swabbing, an admission- and discharge-only approach detected ≥86% of MDRO cases (ie, overall prevalent MDRO colonization). Detection of incident MDRO colonization by an admission- or discharge-only approach would have detected fewer cases than daily swabbing (Figure 1); ≥34% of total MDRO acquisitions would have been missed. Conclusions: Testing patients upon admission and discharge to an MICU may fail to detect MDRO acquisition in more than one-third of patients, thereby reducing the effectiveness of MDRO control programs that are targeted against known MDRO carriers. The poor performance of a single discharge swab may be due to intermittent or low-level MDRO shedding, inadequate sampling, or transient MDRO colonization. Additional research is needed to determine the optimal surveillance approach of enteric MDRO carriage. Funding: No Disclosures: None Cambridge University Press 2021-07-29 /pmc/articles/PMC9551442/ http://dx.doi.org/10.1017/ash.2021.51 Text en © The Society for Healthcare Epidemiology of America 2021 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Surveillance/Public Health
Sansom, Sarah
Lin, Michael
Fukuda, Christine
Shimasaki, Teppei
Dangana, Thelma
Moore, Nicholas
Yelin, Rachel
Rhee, Yoona
Tabith, Lina
Sheng, Jianrong
Cornejo Cisneros, Enrique
Murray, John
Chang, Kyle
Lolans, Karen
Ariston, Michelle
Rotunno, William
Ramos, Hazel
Li, Haiying
Aboushaala, Khaled
Iwai, Naomi
Bassis, Christine
Young, Vincent
Hayden, Mary
Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
title Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
title_full Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
title_fullStr Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
title_full_unstemmed Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
title_short Admission and Discharge Sampling Underestimates Multidrug-Resistant Organism (MDRO) Acquisition in an Intensive Care Unit
title_sort admission and discharge sampling underestimates multidrug-resistant organism (mdro) acquisition in an intensive care unit
topic Surveillance/Public Health
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9551442/
http://dx.doi.org/10.1017/ash.2021.51
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