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Control of Enterobacteriaceae Producing Extended‐Spectrum Beta‐Lactamase in Intensive Care Units: Rectal Screening May Not Be Needed in Non‐Epidemic Situations

Michelle Thouverez, Daniel Talon , PhD and Xavier Bertrand , PhD
Infection Control and Hospital Epidemiology
Vol. 25, No. 10 (October 2004), pp. 838-841
DOI: 10.1086/502305
Stable URL: http://www.jstor.org/stable/10.1086/502305
Page Count: 4
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Control of Enterobacteriaceae Producing Extended‐Spectrum Beta‐Lactamase in Intensive Care Units: Rectal Screening May Not Be Needed in Non‐Epidemic Situations
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Abstract

OBJECTIVE.  To evaluate the usefulness of screening cultures in the control of extended‐spectrum beta‐lactamase (ESBL)–producing Enterobacteriaceae in intensive care units (ICUs). DESIGN.  A 4‐year retrospective study. SETTING.  Two adult ICUs of a university‐affiliated public hospital in France. RESULTS.  A total of 7,777 specimens were analyzed and 28 (0.97%) of 2,883 screened patients had a positive result on a screening test, among the 3,678 admitted patients. Thirteen of these 28 patients were only carriers; 4 were carriers and then were colonized or infected 2, 2, 3, and 8 days later, respectively; and 11 were colonized or infected before a screening test was positive. Cluster analysis showed that the occurrence of ESBL‐producing Enterobacteriaceae cross‐transmission within both ICUs was limited to 9 cases. Thus, most cases (19 of 28) were probably imported. Surveillance cultures failed to detect 9 of the 19 cases. CONCLUSION.  The low prevalence of ESBL‐producing Enterobacteriaceae carriers on admission (0.45%) and the relative ineffectiveness of our screening test to detect imported cases suggest that systematic detection of ESBL‐producing Enterobacteriaceae in ICU patients is not cost‐effective and that the use of clinical cultures may be sufficient to control ESBL‐producing Enterobacteriaceae in non‐epidemic situations.

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