Impact of colonization pressure on acquisition of extended-spectrum β-lactamase-producing Enterobacterales and meticillin-resistant Staphylococcus aureus in two intensive care units: a 19-year retrospective surveillance

S Jolivet; I Lolom; S Bailly; L Bouadma; B Lortat-Jacob; P Montravers; L Armand-Lefevre; J-F Timsit; J-C Lucet

doi:10.1016/j.jhin.2020.02.012

Impact of colonization pressure on acquisition of extended-spectrum β-lactamase-producing Enterobacterales and meticillin-resistant Staphylococcus aureus in two intensive care units: a 19-year retrospective surveillance

J Hosp Infect. 2020 May;105(1):10-16. doi: 10.1016/j.jhin.2020.02.012. Epub 2020 Feb 22.

Authors

S Jolivet¹, I Lolom², S Bailly³, L Bouadma⁴, B Lortat-Jacob⁵, P Montravers⁶, L Armand-Lefevre⁷, J-F Timsit⁴, J-C Lucet⁸

Affiliations

¹ Infection Control Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; IAME, UMR 1137, INSERM, Université de Paris, Paris, France. Electronic address: [email protected].
² Infection Control Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
³ University Grenoble Alpes, INSERM, CHU Grenoble Alpes, HP2, Grenoble, France.
⁴ IAME, UMR 1137, INSERM, Université de Paris, Paris, France; Medical Intensive Care Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁵ Department of Anaesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁶ Department of Anaesthesiology and Intensive Care, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1152, Paris, France.
⁷ IAME, UMR 1137, INSERM, Université de Paris, Paris, France; Bacteriology Laboratory, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
⁸ Infection Control Unit, Bichat University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; IAME, UMR 1137, INSERM, Université de Paris, Paris, France.

PMID: 32092367
DOI: 10.1016/j.jhin.2020.02.012

Abstract

Background: Colonization pressure is a risk factor for intensive care unit (ICU)-acquired multi-drug-resistant organisms (MDROs).

Aim: To measure the long-term respective impact of colonization pressure on ICU-acquired extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and meticillin-resistant Staphylococcus aureus (MRSA).

Methods: All patients admitted to two ICUs (medical and surgical) between January 1997 and December 2015 were included in this retrospective observational study. Rectal and nasal surveillance cultures were obtained at admission and weekly thereafter. Contact precautions were applied for colonized or infected patients. Colonization pressure was defined as the ratio of the number of MDRO-positive patient-days (PDs) of each MDRO to the total number of PDs. Single-level negative binomial regression models were used to evaluate the incidence of weekly MDRO acquisition.

Findings: Among the 23,423 patients included, 2327 (10.0%) and 1422 (6.1%) were colonized with ESBL-PE and MRSA, respectively, including 660 (2.8%) and 351 (1.5%) acquisitions. ESBL-PE acquisition increased from 0.51/1000 patient-exposed days (PEDs) in 1997 to 6.06/1000 PEDs in 2015 (P<0.001). In contrast, MRSA acquisition decreased steadily from 3.75 to 0.08/1000 PEDs (P<0.001). Controlling for period-level covariates, colonization pressure in the previous week was associated with MDRO acquisition for ESBL-PE (P<0.001 and P=0.04 for medical and surgical ICU, respectively), but not for MRSA (P=0.34 and P=0.37 for medical and surgical ICU, respectively). The increase in colonization pressure was significant above 100/1000 PDs for ESBL-PE.

Conclusion: Colonization pressure contributed to the increasing incidence of ESBL-PE but not MRSA. This study suggests that preventive control measures should be customized to MDROs.

Keywords: Colonization pressure; Extended-spectrum β-lactamase-producing Enterobacterales; Incidence; Intensive care units; Meticillin-resistant Staphylococcus aureus; Observational study.

Publication types

Observational Study

MeSH terms

Adult
Aged
Anti-Bacterial Agents / pharmacology
Carrier State
Cross Infection / diagnosis*
Cross Infection / microbiology
Drug Resistance, Multiple, Bacterial
Enterobacteriaceae*
Environmental Monitoring / statistics & numerical data*
Female
Humans
Incidence
Infection Control
Intensive Care Units / statistics & numerical data*
Male
Methicillin / pharmacology
Methicillin-Resistant Staphylococcus aureus*
Middle Aged
Paris
Prospective Studies
Retrospective Studies
Time Factors
beta-Lactamases

Substances

Anti-Bacterial Agents
beta-Lactamases
Methicillin