ESBL-producing infection rate unchanged with universal urine screening

Han J. Infect Control Hosp Epidemiol. 2013;34:1160-1166.

  • November 5, 2013

Universal screening of urine cultures did not reduce the incidence rates of extended-spectrum beta-lactamase–producing Escherichia coli and Klebsiella spp. in hospitals, recent data from a University of Pennsylvania study suggest.

“[Extended-spectrum beta-lactamase–producing E. coli and Klebsiella spp.] emergence in the hospital setting is complex, and further studies are needed on elucidating optimal interventions to limit spread … in acute care hospitals, including the relative importance of contact precautions, hand hygiene adherence and effective antimicrobial stewardship,” the researchers wrote in Infection Control and Hospital Epidemiology.

The researchers screened all clinical urine cultures with E. coli or Klebsiella spp. for extended-spectrum beta-lactamase (ESBL)–producing E. coli or Klebsiella spp. Patients who were colonized or infected were put in private rooms with contact precautions. The monthly nosocomial incidences rates were evaluated.

During the study period, the clinical incidence of ESBL-producing E. coli or Klebsiella spp., measured by nonurinary cultures, increased from 1.42 cases per 10,000 patient-days before the intervention period to 2.16 cases per 10,000 patient-days after the intervention period. Although there was no significant change in nosocomial incidence, there was a significant increase in community-acquired ESBL-producing E. coli or Klebsiella spp. — 0.33 cases per 10,000 patient-days before the intervention period and 0.92 cases per 10,000 patient-days after the intervention period.

“Comprehensive detection of patients colonized or infected with [ESBL–producing E. coli and Klebsiella spp.] is critical for the prompt application of infection control measures designed to prevent transmission … within the hospital setting,” the researchers wrote.

Disclosure: The researchers report no relevant financial disclosures.

Perspective
Brian Currie, MD, MPH

Brian Currie

  • This study highlights the need for continuing research to increase our understanding of the epidemiology of multidrug-resistant organisms. This information is critical for identifying and initiating appropriate and effective control interventions. For example, the study results suggest that there is an increasing prevalence of community-acquired extended-spectrum beta-lactam–producing Escherichia coli and Klebsiella spp., which would have important implications regarding the success of control efforts that only address this MDRO in the acute care environment.
    • Brian Currie, MD, MPH
    • Vice president and medical director for research
      Montefiore Medical Center, New York
  • Disclosures: Currie reports no relevant financial disclosures.