NIJSSEN S, TOP J, WILLEMS R, BOOTSMA M, FLUIT A, BONTEN M; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. K-124.
Univ. Med. Ctr., Utrecht, Netherlands.
BACKGROUND: Acquisition (acq) of colonization (col) can occur via routes with distinct characteristics: a linear process such as "endogenous" (endo) acq (due to antibiotic pressure); or a non-linear process depending on col pressure (exogenous (exo) col). Knowing the relative importance of these routes is essential for designing optimal infection control strategies. Surveillance, epidemiological (epidem) linkage of patients and genotyping are necessary to distinguish both col routes. We have prospectively validated a mathematical model (Pelupessy PNAS2002) to determine the relative importance of both processes using only longitudinal surveillance data. METHODS: During 8 months all patients in 2 ICUs were screened for rectal col with 3rd generation cephalosporin resistant Enterobacteriaceae (CRE) by means of rectal swabs (admission and 2/week), selective media and VITEK-identification. Based on epidem linkage possible cases of cross-acq (sources and acceptors) were identified. 2 isolates per species were genotyped (AFLP) and isolates with >70% similarity underwent PFGE. Definite cases of cross-acq were based on the combination of epidem linkage, AFLP and PFGE. Based on daily prevalence rates of CRE-col patients model predictions were made before genotyping analyses had been performed. RESULTS: Mean endemic prevalence was 22+/-16% (range 0-67%). 65 of 458 patients acquired col with 91 species of CRE. The model predicted that <20% of col resulted from exo col. 170 isolates were genotyped by AFLP and 25 by PFGE. 49 patients had 58 possible events of exo col based on epidem linkage (64%), which was reduced to 6 possible events (10%) based on AFLP results, and to 2 events (3%) based on PFGE results. CONCLUSION: The model predicted predominance of endo col for acq of CRE and could be a simple and inexpensive tool to guide infection control.
Publication Types:
Keywords:
- Anti-Bacterial Agents
- Cephalosporins
- Electrophoresis, Gel, Pulsed-Field
- Enterobacteriaceae
- Enterobacteriaceae Infections
- Humans
- Infection Control
- Intensive Care Units
- Longitudinal Studies
- Models, Biological
- Models, Theoretical
- Prevalence
- Prospective Studies
Other ID:
UI: 102265345
From Meeting Abstracts