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Detection and Treatment of Antibiotic-Resistant Bacterial Carriage in a Surgical Intensive Care Unit: A 6-Year Prospective Survey

Published online by Cambridge University Press:  21 June 2016

Gilles Troché ,
Luc-Marie Toly ,
Michèle Guibert  and
Jean-Fabien Zazzo
Gilles Troché*
Affiliation:
Unité de réanimation chirurgicale, département d'anesthésie-réanimation, hôpital Antoine Béclère, Clamart, France
Luc-Marie Toly
Affiliation:
Unité de réanimation chirurgicale, département d'anesthésie-réanimation, hôpital Antoine Béclère, Clamart, France
Michèle Guibert
Affiliation:
Unité de réanimation chirurgicale, département d'anesthésie-réanimation, hôpital Antoine Béclère, Clamart, France
Jean-Fabien Zazzo
Affiliation:
Unité de réanimation chirurgicale, département d'anesthésie-réanimation, hôpital Antoine Béclère, Clamart, France
*
Medico-surgical Intensive Care Unit, André Mignot Hospital, 177 rue de Versailles, 78157 Le Chesnay Cedex, France. [email protected]
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Abstract

Objective:

To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU).

Design:

Prospective survey of 2,235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E).

Setting:

A surgical ICU in a tertiary-care teaching hospital.

Patients:

All admitted patients.

Interventions:

Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers.

Results:

The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1,000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1,000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBL-E decreased from 5.5 cases per 1,000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage.

Conclusions:

MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 161 - 165
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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