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Is screening for colonisation of extended-spectrum b-lactamase producing Klebsiella pneumoniae in intensive care unit necessary in the absence of an outbreak?

Abstract number: O141

Metan G., Ozkuyumcu C., Koseoglu Eser O., Topeli Iskit A., Hascelik G., Unal S.

Objectives: Extended-spectrum b-lactamase producing Klebiella pnemoniae (ESBL-KP) is a concern of importance for nosocomial infections and responsible for outbreaks particularly in intensive care units (ICUs). Colonisation is a prerequisite for infection by ESBL-KP. The aim of this study was to evaluate the impact of routine detection for colonisation with ESBL-KP in the absence of an outbreak and to detect the rate of infections related to colonisation or transmission.

Methods: This prospective study was conducted in a medical intensive care unit (MICU) with nine beds at Hacettepe University Hospital, a tertiary care centre in Ankara, Turkey. The study was approved by the local ethical comittee. Patients admitted to MICU between August 2002-March 2003 were screened for ESBL-KP by obtaining pharyngeal and rectal swab cultures upon admission, 48th hour of admission and weekly until discharge. The staff of the MICU were not informed about the colonisation status of the patients. Standard infection control practices continued during the study period. All lactose positive and oxidase negative colonies isolated from swabs and cultures, taken when there is a suspicion of infection, were tested for ESBL production and antimicrobial susceptibility testing were performed for ESBL positive isolates according to CLSI recommendations. Enterobacterial repetitive intergenic consensus PCR (ERIC-PCR) method was performed for the evaluation of the genetic diversity.

Results: A total of 100 patients were included in the study and 332 rectal, 332 oropharyngeal swabs were performed from these patients. Eight patients were found to have rectal colonisation with ESBL-KP after 48 hours of ICU admission. ERIC-PCR revealed six different genotypes. One of the colonised patient developed a catheter infection with ESBL-KP. The isolate that was recovered from the catheter infection was found genotypically identical with the colonised strain. The strains that were isolated from three other patients who shared MICU in the same period were all in an unique ERIC-PCR pattern.

Conclusion: Performing routine surveillance cultures for detection of colonisation with ESBL-KP is a hard work for clinical microbiology laboratories. This study indicates that the addition of microbiological screening does not improve the detection or prevention of ESBL infection in the absence of an outbreak.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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