Introduction

The lack of consensus of control measures to prevent extended-spectrum β-lactamase producing Enterobacterales (ESBL-E) transmission in the hospital setting is of great concern. We describe the prevalence and species distribution of ESBL-E and carbapenemase producing Enterobacterales (CPE) in patients admitted in a tertiary Hospital during an active surveillance screening program for detecting ESBL-E carriers and reducing the ESBL-E transmission (R-GNOSIS Project).

Methods

From March-2014 to March-2016, 15,556 rectal swabs were collected from 8209 patients admitted in two medical (Gastroenterology, Pneumology) and two surgical (Neurosurgery, Urology) wards. Swabs were seeded onto ChromoID-ESBL and -CARB/OXA-48 agar plates. Growing colonies were identified by MALDI-TOF MS. ESBL and carbapenemases were phenotypically detected. Changes in species diversity (SDI) and distribution over time were analyzed.

Results

ESBL-E incidence (8.4%) tended to decrease over time (p = 0.003) and CPE carrier prevalence remained unchanged during the study (2%). The contact isolation strategy targeted to reduce ESBL-E transmission was ineffective in reducing ESBL-E carriers but significant differences were observed with CPE (p = 0.017). SDI did not change among ESBL-E and E. coli was predominant (78.5%) during the study. K. pneumoniae (54%) was the most frequent CPE species, followed by E. coli (19%). SDI decreased among the CPE population over time mainly due to K. pneumoniae dominance and increased E. coli prevalence in the last part of the study.

Conclusions

During the R-GNOSIS project, contact precautions were not effective in reducing the ESBL-E transmission but may have had a positive collateral effect on the CPE containment.

中文翻译：

---

大学医院实施接触隔离策略以遏制超广谱β-内酰胺酶携带者，对产碳青霉烯酶肠杆菌的流行病学产生积极影响

 介绍

预防产超广谱 β-内酰胺酶肠杆菌(ESBL-E) 在医院环境中传播的控制措施缺乏共识，这一点值得高度关注。我们描述了在一项旨在检测 ESBL-E 携带者和减少 ESBL-E 传播的主动监测筛查计划（R-GNOSIS 项目）期间，三级医院收治的患者中 ESBL-E 和产碳青霉烯酶肠杆菌(CPE) 的患病率和物种分布。

 方法

从2014年3月到2016年3月，从两个内科（胃肠科、呼吸科）和两个外科（神经外科、泌尿科）病房收治的8209名患者收集了15,556份直肠拭子。将拭子接种到 ChromoID-ESBL 和 -CARB/OXA-48 琼脂平板上。通过 MALDI-TOF MS 鉴定生长中的菌落。表型检测到 ESBL 和碳青霉烯酶。分析了物种多样性（SDI）和分布随时间的变化。

 结果

ESBL-E 发生率 (8.4%) 随着时间的推移呈下降趋势 ( p = 0.003)，而 CPE 携带者患病率在研究期间保持不变 (2%)。旨在减少 ESBL-E 传播的接触隔离策略对于减少 ESBL-E 携带者无效，但与 CPE 观察到显着差异 ( p = 0.017)。在研究期间，ESBL-E 中的 SDI 没有变化，并且大肠杆菌占主导地位 (78.5%)。肺炎克雷伯菌(54%) 是最常见的 CPE 菌种，其次是大肠杆菌(19%)。随着时间的推移，CPE 人群中的 SDI 有所下降，这主要是由于肺炎克雷伯菌占主导地位以及研究最后部分中大肠杆菌患病率的增加。

 结论

在 R-GNOSIS 项目期间，接触预防措施并不能有效减少 ESBL-E 传播，但可能对 CPE 遏制产生积极的附带影响。