Academic Journal
An interventional quasi-experimental study to evaluate the impact of a rapid screening strategy in improving control of nosocomial extended-spectrum beta-lactamase-producing Enterobacterales and carbapenemase-producing organisms in critically ill patients
| العنوان: | An interventional quasi-experimental study to evaluate the impact of a rapid screening strategy in improving control of nosocomial extended-spectrum beta-lactamase-producing Enterobacterales and carbapenemase-producing organisms in critically ill patients |
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| المؤلفون: | Martischang, Romain, Francois, Patrice, Cherkaoui, Abdessalam, Renzi, Gesuele, Fankhauser-Rodriguez, Carolina Maria, Schrenzel, Jacques, Pugin, Jérôme, Harbarth, Stéphan Juergen |
| المصدر: | ISSN: 1364-8535 ; Critical care, vol. 26, no. 1 (2022) 166. |
| سنة النشر: | 2022 |
| المجموعة: | Université de Genève: Archive ouverte UNIGE |
| مصطلحات موضوعية: | info:eu-repo/classification/ddc/616, info:eu-repo/classification/ddc/617, Clinical study, Contact precautions, ICU, Infection control, Molecular test, Multiresistant Gram-negative bacteria, Screening, Surveillance, Bacterial Proteins, Cohort Studies, Critical Illness / therapy, Cross Infection / diagnosis, Cross Infection / epidemiology, Cross Infection / prevention & control, Enterobacteriaceae Infections / diagnosis, Enterobacteriaceae Infections / prevention & control, Humans, Beta-Lactamases |
| الوصف: | Introduction: Rapid molecular tests could accelerate the control of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) and carbapenemase-producing organisms (CPO) in intensive care units (ICUs). Objective and methods: This interventional 12-month cohort study compared a loop-mediated isothermal amplification (LAMP) assay performed directly on rectal swabs with culturing methods (control period, 6 months), during routine ICU screening. Contact precautions (CP) were implemented for CPO or non-E. coli ESBL-producing Enterobacterales (nEcESBL-PE) carriers. Using survival analysis, we compared the time intervals from admission to discontinuation of unnecessary preemptive CP among patients at-risk and the time intervals from screening to implementation of CP among newly identified carriers. We also compared diagnostic performances, and nEcESBL-PE/CPO acquisition rates. This study is registered, ISRCTN 23588440. Results: We included 1043 patients. During the intervention and control phases, 92/147 (62.6%) and 47/86 (54.7%) of patients at-risk screened at admission were candidates for early discontinuation of preemptive CP. The LAMP assay had a positive predictive value (PPV) of 44.0% and a negative predictive value (NPV) of 99.9% for CPO, and 55.6% PPV and 98.2% NPV for nEcESBL-PE. Due to result notification and interpretation challenges, the median time from admission to discontinuation of preemptive CP increased during the interventional period from 80.5 (95% CI 71.5-132.1) to 88.3 (95% CI 57.7-103.7) hours (p = 0.47). Due to the poor PPV, we had to stop using the LAMP assay to implement CP. No difference was observed regarding the incidence of nEcESBL-PE and CPO acquisition. Conclusion: A rapid screening strategy with LAMP assays performed directly on rectal swabs had no benefit for infection control in a low-endemicity setting. |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/35672757; https://archive-ouverte.unige.ch/unige:167063; unige:167063 |
| الاتاحة: | https://archive-ouverte.unige.ch/unige:167063 |
| Rights: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.17E41EBC |
| قاعدة البيانات: | BASE |
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