A predictive score for the result of carbapenem-resistant Enterobacterales and vancomycin-resistant enterococci screening

F Stordeur; A-G Si Larbi; K Le Neindre; J Ory; F Faibis; C Lawrence; F Barbut; D Lecointe; E Farfour; RéFraLHHa group

doi:10.1016/j.jhin.2024.02.024

A predictive score for the result of carbapenem-resistant Enterobacterales and vancomycin-resistant enterococci screening

J Hosp Infect. 2024 Mar 13:148:20-29. doi: 10.1016/j.jhin.2024.02.024. Online ahead of print.

Authors

F Stordeur¹, A-G Si Larbi², K Le Neindre³, J Ory⁴, F Faibis⁵, C Lawrence⁶, F Barbut⁷, D Lecointe⁸, E Farfour⁹; RéFraLHHa group

Collaborators

RéFraLHHa group:
C Andonian¹⁰, F Faure-Audebert¹⁰, C Ciotti¹¹, S Nérome¹¹, P Foucault-Picher¹², F Grade¹³, Marie de Fondaumière¹³, C Durand¹³, Y Costa¹⁴, J-W Decousser¹⁵, J Robert¹⁶, E Kinziger¹⁷, A Migeon¹⁷, L Zon¹⁸, S Delattre¹⁹, J Couturier²⁰, P Moënne-Locoz²¹, H Faury²¹

Affiliations

¹ Structure interne de gestion des risques, hygiène, qualité (SIGRHYQ), Centre Hospitalier Poissy-Saint-Germain en Laye, Poissy, France; Unité de prévention du risque infectieux (UPRI), AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Centre régional en Antibiothérapie (CRAtb) Ile-de-France, Paris, France. Electronic address: florence.stordeur@aphp.fr.
² Service d'hémovigilance, Hôpital Foch, Suresnes, France.
³ Microbiologie de l'environnement, AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Service de Prévention & Contrôle de l'Infection, département des Agents Infectieux, CHU Caen Normandie, Caen, France.
⁴ Service de microbiologie et hygiène hospitalière, CHU Nîmes, Nîmes, France.
⁵ Microbiologie, Grand Hôpital de l'est francilien (GHEF), site Jossigny, France.
⁶ Structure interne de gestion des risques, hygiène, qualité (SIGRHYQ), Centre Hospitalier Poissy-Saint-Germain en Laye, Poissy, France; Equipe opérationnelle d'hygiène, AP-HP Université Paris Saclay, site Raymond-Poincaré, Garches, France; Equipe de prévention des infections, Centre Hospitalier François Quesnay, Mantes-la-Jolie, France.
⁷ Unité de prévention du risque infectieux (UPRI), AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Microbiologie de l'environnement, AP-HP Sorbonne Université - Site Saint-Antoine, Paris, France; Centre National de Référence du Clostridioïdes difficile, Paris, France; INSERM, Faculté de Pharmacie de Paris, Université de Paris, Paris, France.
⁸ Service d'hygiène, Prévention et Contrôle des Infections, Centre Hospitalier Sud Francilien (CHSF), Corbeil-Essonnes, France.
⁹ Service de Biologie Clinique, hôpital Foch, Suresnes, France.
¹⁰ Service de Prévention du risque infectieux, CH Métropole Savoie, site d'Aix-les-bains, Aix-les-bains, France.
¹¹ Service d'Hygiène Hospitalière, Hôpital Beaujon, Clichy, France.
¹² Service de Prévention et Contrôle de l'Infection, Centre Hospitalo-Universitaire Caen Normandie, Caen, France.
¹³ Service de Biologie Clinique, Hôpital Foch, Suresnes, France.
¹⁴ Microbiologie, Grand Hôpital de l'est francilien, Meaux, France.
¹⁵ service de Microbiologie clinique et Laboratoire d'hygiène, hôpital Henri Mondor, Créteil, France.
¹⁶ Bactériologie et Hygiène, hôpital la Pitié-Salpêtrière, Paris, France.
¹⁷ Structure interne de gestion des risques, hygiène, qualité (SIGRHYQ), CHI Poissy-Saint-Germain en Laye, Poissy, France.
¹⁸ Prévention du risque infectieux, hôpital NOVO, Cergy Pontoise, France.
¹⁹ Equipe opérationnelle d'hygiène, Hôpital Raymond-Poincaré, Garches, France.
²⁰ microbiologie de l'environnement, Hôpital Saint-Antoine, Paris, France.
²¹ Unité de prévention du risque infectieux, Hôpital Saint-Antoine, Paris, France.

PMID: 38490490
DOI: 10.1016/j.jhin.2024.02.024

Abstract

Background: The duration of extensively drug-resistant bacteria (XDR) carriage depends on several factors for which the information can be difficult to recover.

Aim: To determine whether past screening and clinical results of patients can predict the results of subsequent screening.

Methods: In total, 256 patients were retrospectively included from 10 healthcare centres in France from January 2014 to January 2022. We created a predictive clearance score, ranging from -5 to +7, that included the number of XDR species and the type of resistance detected in the sample, as well as the time from the last positive sample, the number of previous consecutive negative samples, and obtaining at least one negative PCR result in the collection. This score could be used for the upcoming rectal screening of a patient carrying an XDR as soon as the last screening sample was negative.

Findings: The negative predictive value was >99% for score ≤0. The median time to achieve XDR clearance was significantly shorter for a score of 0 (443 days (259-705)) than that based on previously published criteria.

Conclusion: This predictive score shows high performance for the assessment of XDR clearance. Relative to previous guidelines, it could help to lift specific infection prevention and control measures earlier. Nevertheless, the decision should be made according to other factors, such as antimicrobial use and adherence to hand hygiene.

Keywords: Carbapenem-resistant Enterobacterales; Carriage; Extensively drug-resistant bacteria; Predictive score of clearance; Screening; Vancomycin-resistant enterococci.