Selective vs. Universal Screening for Extended Spectrum Beta Lactamases (ESBL) in a Tertiary Hospital Papakonstantinou D., Cadwgan A., Bodasing N. Department of Infectious Diseases University
Hospital of North Staffordshire (UHNS)
Introduction & Objectives Rising
antibiotic resistance and the decreasing effectiveness of antibiotics are currently
threatening the global community. We
aimed to compare selective screening for ESBL with universal screening in an
Infectious Diseases (ID) Unit. Patients & Methods This
study was conducted during October and December 2013 in the Infectious Diseases
ward of University Hospital of North Staffordshire. Data
was collected on all patients admitted to the ID unit during October 2013,
when hospital guidelines on ESBL screening were followed, and in December
2013 when universal screening for ESBL was carried out. The
hospital guidelines recommend ESBL screening in patients who were admitted
with a long-term urinary catheter in situ, patients who have a history of
ESBL or Multi-Gram negative bacilli (MGNB), patients who have had an
overnight stay in any healthcare facility or care home in the last 12 months
in UK or abroad and patients who have travelled outside Europe in the
previous 12 months. Patients’
data and results were collected from the hospital’s electronic systems. Results Fifty
and fifty-eight patients were admitted in the Infectious Diseases ward during
October and December 2013 respectively. During
October 28/50 patients were screened for ESBL; one of these was found to be
colonised with ESBL (2.0%). Out of the remaining twenty two patients, who
were not screened, 10 (45%) fulfilled criteria for screening. All of these
had a previous inpatient stay or an overnight admission within the last 12
months. During
December all 58 admissions were screened for ESBL and 5 were positive (8.6%).
Out of these, 3 had an inpatient stay, 1 was tagged previously ESBL positive
and 1 did not have any identifiable risk factors.
There
was no significant difference between the 2 groups in terms of number of
positive ESBL screens {chi squared test (p> 0.10)} Conclusions Almost
half the admissions to the ID unit in whom screening was indicated were not
tested for ESBL. There
is a need for further education on the importance of ESBL screening. A universal
screening policy may be more effective at identification of patients
colonised with ESBL. A
further study with a larger sample size is planned to evaluate the impact of
a universal screening policy.
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