Clinical predictive values of extended-spectrum beta-lactamase carriage in patients admitted to medical wards |
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Authors: | E Ruppé A Pitsch F Tubach V de Lastours F Chau B Pasquet J-C Lucet A Andremont and B Fantin |
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Institution: | (1) EA3964, Facult? de M?decine Paris Diderot, Paris, France;(2) Centre National de R?f?rence Associ? “R?sistance dans les flores commensales”, Laboratoire de Bact?riologie, H?pital Bichat-Claude Bernard, AP-HP, 46 Rue Henri Huchard, 75018 Paris, France;(3) Unit? de Recherche Clinique Paris Nord, H?pital Bichat-Claude Bernard, AP-HP, Paris, France;(4) Service de M?decine Interne, H?pital Beaujon, AP-HP, Clichy, France;(5) Unit? de Lutte Contre les Infections Nosocomiales, H?pital Bichat-Claude Bernard, AP-HP, Paris, France |
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Abstract: | We aimed to reassess, through clinical items, populations at risk for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage at admission to hospital and to assess the risk of further positive clinical culture of ESBL-E among carriers.
We performed a 5-month cohort study in a medicine ward of a 500-bed university teaching hospital in the Parisian area of France.
All admitted patients were prospectively enrolled for rectal swabbing and clinical data collection, including bacterial infection
at admission and during stay. Variables associated with ESBL-E carriage were identified by univariate and multivariate analysis.
Five hundred patients were included. The prevalence of ESBL-E was 6.6% (33/500) upon admission. Only previous carriage of
multidrug-resistant bacteria (MDRB) was associated with carriage (odds ratio OR]: 17.7, 95% confidence interval (CI) 5.8–54.2,
p < 0.001), yet, the positive predictive value (PPV) was not higher than 50%. When prior MDRB carriage was not considered in
the multivariate analysis, only prior antibiotic consumption was found to be associated with carriage at admission (OR: 2.2
1.1–4.5], p = 0.02). Two patients had ESBL-E infection at admission, yet, no patient became infected with ESBL-E during their stay. The
clinical prediction of ESBL carriage at admission in our wards was found to be poorly efficient for assessing the at-risk
population. |
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