Experience in Implementing Colonization Screening in a Multidisciplinary County Clinical Hospital in Romania

Skin microbiota plays a crucial role in host defense. Disruptions in this balance can lead to systemic infections. Colonization by pathogenic microorganisms significantly increases the risk of symptomatic infections, prolongs hospital stays and increases healthcare costs. In Romania, the widespread misuse of antibiotics in the community further complicates the management of bacterial resistance, emphasizing the need for proactive measures. Our institution implemented a comprehensive multi-body-site colonization screening protocol starting from January 2024 until June 2024. The screening targeted high-risk patients, including those in ICUs, Oncology, and Hematology Clinics, and individuals with prior hospitalizations, antibiotic use, or medical devices. This study aimed to investigate the prevalence of colonization by multidrug-resistant organisms upon hospital admission and assess the changes in colonization rates during hospitalization. Samples from nasal, axillary, inguinal, and rectal swabs were processed on specialized chromogenic media to detect multidrug-resistant organisms such as methicillin-resistant S. aureus (MRSA), ESBL-producing Enterobacterales, and carbapenemase-producing bacteria. During the first two trimesters of the year 2024, 1522 patients aged 14 to 99 years underwent multi-body-site colonization screening at the County Clinical Emergency Hospital Sibiu, Romania. A total of 18,993 samples were analyzed, yielding a diverse range of bacterial isolates. The most common results were Escherichia coli-ESBL-negative (3584 cases, 18.9%) and the KESC bacteria group (Klebsiella spp., Enterobacter spp., Serratia spp., and Citrobacter spp.)-MDR-negative (3435 cases, 18.1%). Conversely, positive results were less frequent, with Acinetobacter baumannii-MDR-positive results in 62 cases (0.3%), E. coli-ESBL-positive results in 342 cases (1.8%), and KESC group-MDR-positive results in 491 cases (2.6%). Other notable findings included Enterococcus faecium-VRE-positive (157 cases, 0.8%) and MRSA-positive nasal swabs (141 cases, 0.7%). Rare isolates included Enterococcus faecalis-VRE-positive (4 cases, 0.0%) and Proteeae group-MDR-positive (33 cases, 0.2%). Negative screening for MRSA was prevalent across nasal (1850 cases, 9.7%), inguinal (742 cases, 3.9%), and axillary swabs (1124 cases, 5.9%), with substantially lower positive rates. The diversity of swab types and their distribution across various clinics and departments underscores the broad diagnostic approaches and patient-care strategies adopted during the study. These findings highlight the need for tailored infection prevention strategies and continuous surveillance to mitigate the spread of multidrug-resistant organisms and enhance patient safety across diverse clinical environments.