Nosocomial acquisition of methicillin-resistant Staphyloccocus aureus (MRSA) and extended-spectrum beta-lactamase (ESBL) Enterobacteriaceae in hospitalised patients: a prospective multicenter study

Giulia De Angelis, Giovanni Restuccia, Silvia Venturiello, Roberto Cauda, Surbhi Malhotra-Kumar, Herman Goossens, Jacques Schrenzel, Evelina Tacconelli, Giulia De Angelis, Giovanni Restuccia, Silvia Venturiello, Roberto Cauda, Surbhi Malhotra-Kumar, Herman Goossens, Jacques Schrenzel, Evelina Tacconelli

Abstract

Background: The risk of acquisition of antibiotic resistant-bacteria during or shortly after antibiotic therapy is still unclear and it is often confounded by scarce data on antibiotic usage.Primary objective of the study is to compare rates of acquisition of methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae in hospitalised patients, after starting antibiotic therapy.

Methods/design: The study, running in three European hospitals, is a multicenter, prospective, longitudinal, observational cohort study funded from the European Community's Seventh Framework Programme [FP7/2007-2013] within the project 'Impact of Specific Antibiotic Therapies on the prevalence of hUman host ResistaNt bacteria' (acronym SATURN). Nasal and rectal screening for methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae will be obtained at hospital admission, discharge, at antibiotic start (t0, within one hour) and at the following intervals: day 3 (t1), 7 (t2), 15 (t3), and 30 (t4). Two nested case-control studies will be performed. The objective of the first study will be to define individual level of risk related to specific antibiotics. Patients acquiring methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae (cases) will be compared with patients not acquiring antibiotic-resistant strains after starting antibiotic therapy (controls; ratio 1:4). To define the impact of antibiotics on new acquisition of target antibiotic-resistant bacteria, a second nested case-control study will be done (ratio 1:4). Control group will be selected among patients not receiving antibiotics, admitted in the same ward on the day of the corresponding case, with negative cultures at admission. Epidemiological, clinical and microbiological data will be prospective collected.

Discussion: The rationale of this study is to better understand the impact of antibiotic use on acquisition, selection and transmission of antimicrobial resistant-bacteria in European hospitals.

Trial registration: ClinicalTrials.gov NCT01208519.

Figures

Figure 1
Figure 1
Work flow of the SATURN WP4 clinical protocol.

References

    1. Muto CA. Why are antibiotic-resistant nosocomial infections spiraling out of control? Infect Contr Hosp Epidemiol. 2004;26(1):10–12.
    1. Wenzel RP. Health care-associated infections: major issues in the early years of the 21st century. Clin Infect Dis. 2007;45(Suppl 1):S85–S88.
    1. Pitout JD, Laupland KB. Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern. Lancet Infect Dis. 2008;8(3):159–166. doi: 10.1016/S1473-3099(08)70041-0.
    1. Tacconelli E, De Angelis G, Cataldo MA, Mantengoli E, Spanu T, Pan A, Corti G, Radice A, Stolzuoli L, Antinori S, Paradisi F, Carosi G, Bernabei R, Antonelli M, Fadda G, Rossolini GM, Cauda R. Antibiotic usage and risk of colonization and infection with antibiotic-resistant bacteria: a hospital population-based study. Antimicrob Agents Chemother. 2009;53(10):4264–4269. doi: 10.1128/AAC.00431-09.
    1. Rodriguez-Bano J, Navarro MD, Romero L, Muniain MA, Cueto M, Galvez J, Perea EJ, Pascual A. Risk-factors for emerging bloodstream infections caused by extended-spectrum beta-lactamase-producing Escherichia coli. Clin Microbiol Infect. 2008;14(2):180–183.
    1. Song JY, Cheong HJ, Jo YM, Choi WS, Noh JY, Heo JY, Kim WJ. Vancomycin-resistant Enterococcus colonization before admission to the intensive care unit: a clinical-epidemiologic analysis. Am J Infect Control. 2009;37(9):734–740. doi: 10.1016/j.ajic.2008.09.025.
    1. Tacconelli E, De Angelis G, Cataldo MA, Pozzi E, Cauda R. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta- analysis. J Antimicrob Chemother. 2008;61(1):26–38.
    1. Hyle EP, Bilker WB, Gasink LB, Lautenbach E. Impact of different methods for describing the extent of prior antibiotic exposure on the association between antibiotic use and antibiotic-resistant infection. Infect Control Hosp Epidemiol. 2007;28(6):647–654. doi: 10.1086/516798.
    1. Carmeli Y, Samore MH, Huskins C. The association between antecedent vancomycin treatment and hospital-acquired vancomycin-resistant enterococci: a meta-analysis. Arch Intern Med. 1999;159(20):2461–2468. doi: 10.1001/archinte.159.20.2461.
    1. Tacconelli E. Antimicrobial use: risk driver of multidrug resistant microorganisms in healthcare settings. Curr Opin Infect Dis. 2009;22(4):352–358. doi: 10.1097/QCO.0b013e32832d52e0.
    1. Malhotra-Kumar S, Abrahantes JC, Sabiiti W, Lammens C, Vercauteren G, Ieven M, Molenberghs G, Aerts M, Goossens H. MOSAR WP2 Study Team. Evaluation of chromogenic media for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2010;48(4):1040–1046. doi: 10.1128/JCM.01745-09.
    1. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI, Wayne, PA; 2009. 19th Information supplement M100-S19.
    1. Pfaller MA, Segreti J. Overview of the epidemiological profile and laboratory detection of extended-spectrum beta-lactamases. Clin Infect Dis. 2006;42(Suppl 4):S153–S163.

Source: PubMed

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