Improved quality of care for patients infected or colonised with ESBL-producing Enterobacteriaceae in a French teaching hospital: impact of an interventional prospective study and development of specific tools

Eur J Clin Microbiol Infect Dis. 2018 May;37(5):977-981. doi: 10.1007/s10096-018-3234-6. Epub 2018 Mar 28.

Abstract

The increasing incidence of ESBL-producing Enterobacteriaceae (ESBL-E) in France prompted the publication of national recommendations in 2010. Based on these, we developed a toolkit and a warning system to optimise management of ESBL-E infected or colonised patients in both community and hospital settings. The impact of this initiative on quality of care was assessed in a teaching hospital. The ESBL toolkit was developed in 2011 during multidisciplinary meetings involving a regional network of hospital, private clinic and laboratory staff in Southeastern France. It includes antibiotic treatment protocols, a check list, mail templates and a patient information sheet focusing on infection control. Upon identification of ESBL-E, the warning system involves alerting the attending physician and the infectious disease (ID) advisor, with immediate, advice-based implementation of the toolkit. The procedure and toolkit were tested in our teaching hospital. Patient management was compared before and after implementation of the toolkit over two 3-month periods (July-October 2010 and 2012). Implementation of the ESBL-E warning system and ESBL-E toolkit was tested for 87 patients in 2010 and 92 patients in 2012, resulting in improved patient management: expert advice sought and followed (16 vs 97%), information provided to the patient's general practitioner (18 vs 63%) and coding of the condition in the patient's medical file (17 vs 59%), respectively. Our multidisciplinary strategy improved quality of care for in-patients infected or colonised with ESBL-E, increasing compliance with national recommendations.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Cross Infection*
  • Enterobacteriaceae / drug effects
  • Enterobacteriaceae / genetics*
  • Enterobacteriaceae Infections / diagnosis
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology*
  • Female
  • France / epidemiology
  • Hospitals, Teaching*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Prospective Studies
  • Quality Improvement
  • Quality of Health Care*
  • beta-Lactam Resistance
  • beta-Lactamases / genetics*

Substances

  • Anti-Bacterial Agents
  • beta-Lactamases