Duration of carriage of multidrug resistant Enterobacterales in discharged hospital and general practice patients and factors associated with clearance

Celine van Weerlee; Eric R van der Vorm; Loes Nolles; Saskia Meeuws-van den Ende; Akke K van der Bij

doi:10.1016/j.infpip.2020.100066

Duration of carriage of multidrug resistant Enterobacterales in discharged hospital and general practice patients and factors associated with clearance

Infect Prev Pract. 2020 May 19;2(3):100066. doi: 10.1016/j.infpip.2020.100066. eCollection 2020 Sep.

Authors

Celine van Weerlee^{1

2}, Eric R van der Vorm¹, Loes Nolles¹, Saskia Meeuws-van den Ende¹, Akke K van der Bij^{1

3}

Affiliations

¹ Department of Medical Microbiology, Reinier de Graaf Groep, PO Box 5011, 2600 GA Delft, the Netherlands.
² Department of Medical Microbiology and Infection Prevention, Gelre Ziekenhuizen, Apeldoorn, the Netherlands.
³ Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands.

Abstract

Objectives: Dutch guidelines recommend contact precautions in patients with multidrug resistant microorganisms cultured during the previous 12 months. To evaluate this policy, duration of carriage of multidrug resistant Enterobacterales was assessed among discharged hospital patients and patients attending their general practitioner (GP). Additionally, we assessed factors associated with clearance.

Methods: From January 2013 until May 2016, rectal or faecal samples accompanied by questionnaires on patient characteristics were obtained at time of study inclusion and 3, 6 and 12 months later, in 72 patients with multidrug resistant Enterobacterales. Clearance was defined as one or more negative cultures without a subsequent positive culture at 12 months after study inclusion. The percentage of clearance, intermittent carriage and persistence was determined and associated factors were assessed by logistic regression analysis.

Results: Clearance was found in 31 patients (43.1% [95%CI: 32.3-54.6]) of which 23 patients had two or more subsequent negative cultures. Twelve patients were classified as intermittent carriers (16.7% [95%CI: 9.8-26.9]) and 29 patients (40.3% [95% CI: 29.7-51.8]) as persistent carriers. Of the intermittent carriers, the majority (n=9) had two negative cultures during the study period. There was no difference in clearance between discharged hospitalized patients and GP patients. The only factor associated with clearance at 12 months in both univariable and multivariable analyses was not traveling to a foreign country (OR=3.5 [95%CI: 1.0-12.4]).

Conclusion: Active screening for clearance of multidrug resistant Enterobacterales in patients within the health care setting is probably not beneficial due to high levels of intermittent and persistent carriage.

Keywords: Carriage; EPD, electronic patient record; ESBL, extended-spectrum beta-lactamase; GP, general practitioner; HRMO, highly resistant microorganisms; Infection prevention; Multidrug resistant Enterobacterales.