Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened?

Kaspar, Tanja; Schweiger, Alexander; Droz, Sara Christine; Marschall, Jonas (2015). Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened? Antimicrobial Resistance and Infection Control, 4(31), p. 31. BioMed Central 10.1186/s13756-015-0071-6

[img] Text
s13756-015-0071-6.pdf - Published Version
Available under License Creative Commons: Attribution (CC-BY).

Download (420kB)

BACKGROUND

While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk.

METHODS

This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA).

RESULTS

A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p < 0.001), surgical procedure in a hospital abroad (p = 0.007), and - on admission to our hospital - active infection (p = 0.002), antibiotic treatment (p = 0.014) and presence of skin lesions (p = 0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization.

CONCLUSION

Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology
04 Faculty of Medicine > Service Sector > Institute for Infectious Diseases

UniBE Contributor:

Kaspar, Tanja; Schweiger, Alexander; Droz, Sara Christine and Marschall, Jonas

Subjects:

600 Technology > 610 Medicine & health
500 Science > 570 Life sciences; biology

ISSN:

2047-2994

Publisher:

BioMed Central

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

30 Sep 2015 15:25

Last Modified:

08 Jun 2017 11:56

Publisher DOI:

10.1186/s13756-015-0071-6

PubMed ID:

26213620

Uncontrolled Keywords:

Colonization; Gram–negative bacteria; International travel; Multi-drug resistant organisms; Screening

BORIS DOI:

10.7892/boris.70691

URI:

https://boris.unibe.ch/id/eprint/70691

Actions (login required)

Edit item Edit item
Provide Feedback