Time to intestinal clearance of ...
Document type :
Article dans une revue scientifique: Article original
PMID :
Permalink :
Title :
Time to intestinal clearance of carbapenemase-producing Enterobacterales in hospital patients: a longitudinal retrospective observational cohort study.
Author(s) :
Loukili, N. Henoun [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Loquet, A. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Perrin, A. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Gaillot, O. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Bruandet, Amelie [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Sendid, Boualem [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Zahar, J. R. [Auteur]
Hôpital Avicenne [AP-HP]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Loquet, A. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Perrin, A. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Gaillot, O. [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Bruandet, Amelie [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
METRICS : Evaluation des technologies de santé et des pratiques médicales - ULR 2694
Sendid, Boualem [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Zahar, J. R. [Auteur]
Hôpital Avicenne [AP-HP]
Nseir, Saad [Auteur]
Unité de Glycobiologie Structurale et Fonctionnelle (UGSF) - UMR 8576
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Journal title :
Journal of Hospital Infection
Abbreviated title :
J Hosp Infect
Publication date :
2023-03-06
ISSN :
1532-2939
English keyword(s) :
Carbapenemase-producing
enterobacterales
Gut clearance
Decolonization
enterobacterales
Gut clearance
Decolonization
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Background
Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone to discontinue isolation precautions for CPE patients in hospitals. This study aimed to evaluate the time to spontaneous ...
Show more >Background Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone to discontinue isolation precautions for CPE patients in hospitals. This study aimed to evaluate the time to spontaneous CPE-IC and identify its potential associated risk factors. Methods This retrospective cohort study was carried out between January 2018 and September 2020 on all patients in a 3200-bed teaching referral hospital with confirmed CPE intestinal carriage. CPE-IC was defined as at least three consecutive CPE-negative rectal swab cultures without a subsequent positive result. A survival analysis was performed to determine the median time to CPE-IC. A multivariate Cox model was implemented to explore the factors associated with CPE-IC. Results A total of 110 patients were positives for CPE, of whom 27 (24.5%) achieved CPE-IC. Median time to CPE-IC was 698 days. Univariate analysis showed that female sex (P=0.046), multiple CPE-species in index cultures (P=0.005), Escherichia coli or Klebsiella spp. (P=0.001 and P=0.028, respectively) were significantly associated with the time to CPE-IC. Multivariate analysis highlighted that identification of E. coli carbapenemase-producing or CPEs harbouring ESBL genes in index culture extended the median time to CPE-IC, respectively (adjusted hazard ratio (aHR) = 0.13 (95% confidence interval: 0.04–0.45]; P=0.001 and aHR = 0.34 (95% confidence interval: 0.12–0.90); P=0.031). Conclusion Intestinal decolonization of CPE can take several months to years to occur. Carbapenemase-producing E. coli are likely to play a key role in delaying intestinal decolonization, probably through horizontal gene transfer between species. Therefore, discontinuation of isolation precautions in CPE-patients should be considered with caution.Show less >
Show more >Background Intestinal clearance of carbapenemase-producing Enterobacterales (CPE-IC) is a cornerstone to discontinue isolation precautions for CPE patients in hospitals. This study aimed to evaluate the time to spontaneous CPE-IC and identify its potential associated risk factors. Methods This retrospective cohort study was carried out between January 2018 and September 2020 on all patients in a 3200-bed teaching referral hospital with confirmed CPE intestinal carriage. CPE-IC was defined as at least three consecutive CPE-negative rectal swab cultures without a subsequent positive result. A survival analysis was performed to determine the median time to CPE-IC. A multivariate Cox model was implemented to explore the factors associated with CPE-IC. Results A total of 110 patients were positives for CPE, of whom 27 (24.5%) achieved CPE-IC. Median time to CPE-IC was 698 days. Univariate analysis showed that female sex (P=0.046), multiple CPE-species in index cultures (P=0.005), Escherichia coli or Klebsiella spp. (P=0.001 and P=0.028, respectively) were significantly associated with the time to CPE-IC. Multivariate analysis highlighted that identification of E. coli carbapenemase-producing or CPEs harbouring ESBL genes in index culture extended the median time to CPE-IC, respectively (adjusted hazard ratio (aHR) = 0.13 (95% confidence interval: 0.04–0.45]; P=0.001 and aHR = 0.34 (95% confidence interval: 0.12–0.90); P=0.031). Conclusion Intestinal decolonization of CPE can take several months to years to occur. Carbapenemase-producing E. coli are likely to play a key role in delaying intestinal decolonization, probably through horizontal gene transfer between species. Therefore, discontinuation of isolation precautions in CPE-patients should be considered with caution.Show less >
Language :
Anglais
Audience :
Internationale
Popular science :
Non
Administrative institution(s) :
Université de Lille
CHU Lille
CHU Lille
Submission date :
2023-11-15T02:23:07Z
2024-04-12T12:34:10Z
2024-04-12T12:34:10Z