Author: Chan, Fung Yee Regina
Title: Intestinal carriage of extended-spectrum β-lactamase-producing enterobacteriaceae (ESBL-PE) in intensive care unit (ICU)
Degree: M.Sc.
Year: 2013
Subject: Beta lactamases
Intensive care units.
Nosocomial infections -- Prevention.
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xi, 90 leaves : color illustrations ; 30 cm
Language: English
Abstract: Background: The bacterial resistance to antimicrobial treatment is a known problem worldwide as a result of liberal use of antibiotic and non-compliance to infection control practice. Extended-spectrum {461}-lactamase-producing Enterobacteriaceae (ESBL-PE) is one of the multidrug resistant organisms causing global challenge. Apart from threatening the successful treatment of patient, the strategy of "search and kill" has caused much stress and workload to the infection control system. Furthermore, there is an increasing concern on emerging carbapenemase-producing Enterobacteriaceae. Local data in the study hospital revealed that the proportion of ESBL positive Escherichia coli and Klebsiella species increased from 25.2% and 13.8% in 2010 to 29.7% and 15.7% in 2011, respectively. In Hong Kong, there is limited data about the intestinal carriage of ESBL-PE especially in intensive care unit (ICU) patient who is one of the at risk groups. These organisms vary between geographical regions, hospitals and time resulting in limited choice of antibiotic, overburden of infection control system, and raised patient morbidity and mortality. Objectives: To determine the prevalence of the intestinal carriage of ESBL-PE in a cohort of ICU patients, investigate the risk factors associated with its acquisition and follow up on those patients screened for ESBL-PE. Design: A prevalence study. Setting: A 19-bed intensive care unit of an acute care hospital in Hong Kong. Methods: The study was conducted in ICU during the period of 1st May 7th October 2012. Stool or rectal swabs were collected from all patients on admission to and or discharge from ICU, and the patients were followed up till discharge from the hospital. The specimens were cultured on ChromIDTM ESBL agar and processed according to the standard laboratory protocol. A standardized surveillance template was used for data collection.
Results: A total of 322 patients were included for analysis. There were 186 (57.8%) male and 136 (42.2%) female; the mean age was 61 years old (range 18 - 92). Among them, 11 (3.4%) were elderly home residents. Around 60% were admitted from Accident and Emergency Department (AED) or transferred in from other hospitals. Twenty-five patients had ESBL-PE isolated from clinical samples collected from blood, intra-abdominal cavity / peritoneum, urinary, respiratory tract or wound. The overall proportion of intestinal carriage of ESBL-PE was 53.4% (172/322). There was 48.4% (154/318) found positive for ESBL-PE intestinal carriage at the time of ICU admission. Among 172 cases, 113 (65.7%), 12 (7%) and 47 (27.3%) were categorized as community acquired, ICU acquired and probable hospital acquired cases, respectively. ESBL-producing Escherichia coli was the most common isolate contributing to 76.2% of the cases. No significant risk factors were identified for the patients with a positive ESBL-PE faecal carriage for this cohort of ICU patients. However; the length of hospital stay, diabetes mellitus, hepatobiliary disease and ESBL-PE positive carriage were found to be significantly associated with ESBL-PE clinical infection. For the patients (n=154) with positive ESBL-PE carriage on admission screening; the length of hospital stay and chronic lung disease were found to be significantly associated with ESBL-PE clinical infection. For the patients (n=100) with negative / unknown ESBL-PE carriage on admission screening; the exposure to instrumentation was found to be significantly associated with positive ESBL-PE status of discharge screening swab. Conclusion: The overall proportion of intestinal carriage of ESBL-PE was 53.4% in the ICU patients during the study period and the proportion of ESBL-PE carriage identified on admission to ICU was 48.4%; this limited and complicated the empirical choice of antimicrobial therapy for patients with sepsis. The infection control strategy of "search and kill" became more challenging. This highlighted the importance of infection control risk assessment and the stringent application of "Standard Precautions" for the care of all patients. To combat against the emergence of antibiotic resistance, critical use of antibiotics should focus on the clinical situation and local epidemiology. Extra efforts on the prudent use of antimicrobials in the community and agricultural industry were urgently required.
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Access: restricted access

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