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Published on: March 3, 2023
Variability of intestinal colonization with third-generation cephalosporin-resistant Enterobacteriaceae and
Anne C M Thiébaut1, Guillaume Arlet, Antoine Andremont
1INSERM, U657, Paris, France. anne.thiebaut@pasteur.fr
Objectives:
Healthcare-associated infections due to third-generation cephalosporin-resistant Enterobacteriaceae (CRE) have become a major public health threat, especially in intensive care units (ICUs). We assessed and compared β-lactam use, the prevalence of colonization with CRE at admission and the incidence of CRE acquisition across ICUs.
Patients And Methods:
A cohort study was conducted in 10 ICUs of the Paris (France) metropolitan area between November 2005 and February 2006. Antibiotic use was recorded prospectively in all patients admitted during the study period. Rectal swabs were collected at admission, twice weekly thereafter, before β-lactam prescription and before discharge.
Results:
A total of 893 patients provided 3453 rectal swabs; 793 of the patients were newly admitted, mostly for medical reasons (80.7%). On admission, 74 patients (9.6%) were colonized with CRE, including 32 with an extended-spectrum β-lactamase (ESBL)-producing strain. Among the remaining 694 naive patients, 94 acquired CRE during their follow-up, including 31 with an ESBL-producing strain. Incidence rates of colonization ranged from 8.8 to 21.0/1000 patient-days for all CRE, and from 1.4 to 10.9/1000 patient-days for ESBL producers. A majority of patients (68.3%) were prescribed β-lactams during their ICU stay, with defined daily doses ranging from 428 to 985/1000 patient-days. Across ICUs, prescriptions of all antibiotics, β-lactams and carbapenems were significantly correlated to incidence rates of colonization with ESBL-producing CRE.
Conclusions:
The standardized and systematic follow-up of patients in 10 ICUs revealed great heterogeneity in the rates of colonization with ESBL- and non-ESBL-producing CRE, as well as in antimicrobial prescription practices.
Insights
Healthcare-associated infections from cephalosporin-resistant Enterobacteriaceae (CRE) are a major threat. This study found significant variation in CRE colonization and antibiotic use across intensive care units (ICUs).
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Antimicrobial Resistance
Background:
- Healthcare-associated infections (HAIs) caused by third-generation cephalosporin-resistant Enterobacteriaceae (CRE) pose a significant public health challenge, particularly within intensive care units (ICUs).
- Understanding the dynamics of CRE colonization and acquisition is crucial for developing effective control strategies.
Purpose of the Study:
- To assess and compare the use of β-lactam antibiotics.
- To determine the prevalence of colonization with CRE upon ICU admission.
- To evaluate the incidence of CRE acquisition during ICU stays.
Main Methods:
- A prospective cohort study was conducted across 10 ICUs in the Paris metropolitan area.
- Antibiotic use was meticulously recorded, and rectal swabs were collected from patients at admission, multiple times weekly, before β-lactam prescription, and at discharge.
- Data from 893 patients and 3453 rectal swabs were analyzed.
Main Results:
- On admission, 9.6% of patients were colonized with CRE, including 32 with extended-spectrum β-lactamase (ESBL)-producing strains.
- Among CRE-naive patients, 13.5% acquired CRE during their ICU stay, with 31 cases involving ESBL producers.
- Significant correlations were observed between the prescription rates of all antibiotics, β-lactams, and carbapenems, and the incidence of colonization with ESBL-producing CRE.
Conclusions:
- A notable heterogeneity exists in CRE colonization rates (both ESBL- and non-ESBL-producing) across different ICUs.
- Antimicrobial prescription practices, particularly β-lactam use, varied significantly among the participating ICUs.
- These findings highlight the need for standardized surveillance and antimicrobial stewardship programs to combat CRE spread in ICUs.
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