Targeted screening for third-generation @entity5898 -resistant Enterobacteriaceae carriage among XXXX admitted to intensive care units: a quasi-experimental study.

@entity1 @entity5394 @entity5898 @entity12623 @entity580 @entity130
INTRODUCTION: Identification of third-generation, @entity5898 -resistant Enterobacteriaceae (3GC-RE) carriers by rectal screening at admission seems to be an important step in the prevention of transmission and outbreaks; however, little is known about its effectiveness. The aim of this study was to evaluate the impact of 'targeted screening' at @entity1 admission to intensive care units (ICUs) on the incidence of 3GC-RE @entity580 ( @entity580 ) and compare it to 'universal screening'. METHODS: We undertook a quasi-experimental study of two ICUs (unit A: intervention group; unit B: control group) at a university-affiliated hospital between 1 January 2008 and 31 December 2011. In unit A, @entity1 were screened universally for 3GC-RE at admission during period 1 (1 January 2008 through 30 September 2010). During @entity5394 (2011 calendar year), the intervention was implemented in unit A; @entity1 transferred from another unit or hospital were screened selectively. In unit B, all @entity1 were screened throughout @entity5394 . 3GC-RE-related HAI incidence rates were expressed per 1,000 @entity1 -days. Incidence rate ratios (IRRs) were examined by multivariate Poisson regression modelling. RESULTS: In unit A, 3GC-RE-related HAI incidence rates decreased from 5.4 (95% confidence interval (CI), 4.1 to 7.0) during period 1 to 1.3 (95% CI, 0.5 to 2.9) during @entity5394 (P   <   0.001). No changes were observed in unit B between @entity5394 (P   =   0.5). In unit A, the adjusted incidence of 3GC-RE-related @entity580 decreased in @entity5394 compared with period 1 (adjusted @entity12623 , 0.3; 95% CI, 0.1 to 0.9; P   =   0.03) independently of temporal trend, @entity130 and age. No changes were seen in unit B (P   =   0.4). The total number of rectal swabs taken showed an 85% decrease in unit A between @entity5394 (P   <   0.001). CONCLUSIONS: Targeted screening of 3GC-RE carriers at ICU admission was not associated with an increase in 3GC-RE-related HAI incidence compared with universal screening. Total number of rectal swabs decreased significantly. These findings suggest that targeted screening may be worth assessing as an alternative to universal screening.
