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Surveillance of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in a Swiss Tertiary Care Hospital

Fankhauser, C.
Dharan, S.
Published in Swiss medical weekly. 2009, vol. 139, no. 51-52, p. 747-751
Abstract BACKGROUND: Extended spectrum beta-lactamase producing enterobacteriaceae (ESBL-E) are increasing worldwide, but there is sparse data on patient-to-patient transmission and the prevalence among risk groups in Switzerland. A prospective, observational cohort study was performed to: 1) assess the prevalence of ESBL-E at admission among at-risk groups; 2) evaluate nosocomial cross-transmission in acute care (ACF) versus long-term care facilities (LTCF); and 3) evaluate prevalent mutations of the detected beta-lactamase genes. METHODS: Predefined risk groups were screened either on admission or after having been in contact with index patients diagnosed with ESBL-E by clinical cultures. Three patient categories were distinguished: patients previously known to be ESBL-E carrier (category I); patients transferred from countries with known high ESBL-E prevalence and thus at risk for ESBL-E carriage (category II); and roommates of index patients (category III). RESULTS: A total of 93 patients with ESBL-E were identified: Sixty-two percent (31/50) of category I patients were positive when screened upon rehospitalisation (category I); eighteen percent (22/124) of category II patients; and eight out of 177 category III patients (4.5%) of which five showed identical ESBL-E strains or shared the same beta-lactamase gene as their index cases. The incidence density of transmission was 0.9/1000 exposure-days, with more transmissions in ACF than in LTCF (4.2 vs 0.4/1000 exposure days). CTX-M-15 was the predominant beta-lactamase gene (60%) among the index patients. CONCLUSIONS: The prevalence of ESBL-E carriage among patients coming from regions with endemic rates or those previously identified as carriers is high; on-admission screening should be considered for these high risk populations. Documented nosocomial ESBL-E transmission was low.
Keywords Academic Medical CentersAdolescentAdultAgedAged, 80 and overBacteremia/epidemiologyCohort StudiesEnterobacteriaceae/drug effects/enzymology/ pathogenicityEnterobacteriaceae Infections/epidemiologyFemaleHumansMaleMiddle AgedPopulation SurveillanceRetrospective StudiesSwitzerlandYoung AdultBeta-Lactam ResistanceBeta-Lactamases/ metabolism
PMID: 19924582
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Other version: http://www.smw.ch/dfe/set_archiv.asp?target=smw-12918
Research groups Epidémiologie et contrôle de la résistance aux antibiotiques (866)
Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière (330)
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FANKHAUSER, C. et al. Surveillance of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in a Swiss Tertiary Care Hospital. In: Schweizerische medizinische Wochenschrift, 2009, vol. 139, n° 51-52, p. 747-751. https://archive-ouverte.unige.ch/unige:7199

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Deposited on : 2010-06-21

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