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Screening for Intestinal Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae in Critically Ill Patients: Expected Benefits and Evidence-based Controversies

  • Zahar, Jean-Ralph Infection Control Unit, Avicenne University Hospital, Assistance Publique - Hôpitaux de Paris, Bobigny - INSERM, Infection Antimicrobial Modelling Evolution, Sorbonne Paris Cité University, France
  • Blot, Stijn Department of Internal Medicine, Ghent University, Belgium - Burns, Trauma and Critical Care Research Centre, Centre for Clinical Research, Faculty of Medicine, University of Queensland, Brisbane, Australia
  • Nordmann, Patrice Medical and Molecular Microbiology Unit, Department of Medicine, University of Fribourg, Switzerland - Swiss National Reference Center for Emerging Antibiotic Resistance, University of Fribourg, Switzerland - Institute for Microbiology, University of Lausanne and University Hospital Centre, Switzerland
  • Martischang, Romain Infection Control Program and World Health Organization Collaborating Center, Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Switzerland
  • Timsit, Jean-François INSERM, Infection Antimicrobial Modelling Evolution, Sorbonne Paris Cité University, France - Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, Paris, France
  • Harbarth, Stephan Infection Control Program and World Health Organization Collaborating Center, Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Switzerland
  • Barbier, François Medical Intensive Care Unit, La Source Hospital, Orléans, France
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    2018
Published in:
  • Clinical Infectious Diseases. - 2019, vol. 68, no. 12, p. 2125-2130
English The rising burden of intensive care unit (ICU)-acquired infections due to extended- spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) strengthens the requirement for efficient prevention strategies. The detection of intestinal carriage of ESBL-E through active surveillance cultures (ASC) and the implementation of contact precautions (CP) in carriers are currently advocated in most high-income countries, to prevent cross-transmission and subsequent ESBL-E infections in critically-ill patients. Yet, recent studies have challenged the benefit of ASC and CP in controlling the spread of ESBL-E in ICUs with high compliance to standard hygiene precautions and no ongoing outbreak of ESBL-producing Klebsiella pneumoniae or Enterobacter spp. Besides, given their debated performance to positively predict which patients are at risk of ESBL-E infections, ASC results appear of limited value to rationalize the empirical use of carbapenems in the ICU, emphasizing the urgent need for novel anticipatory and diagnostic approaches. This Viewpoint article summarizes the available evidence on these issues.
Faculty
Faculté des sciences et de médecine
Department
Médecine 3ème année
Language
  • English
Classification
Biological sciences
License
License undefined
Identifiers
Persistent URL
https://folia.unifr.ch/unifr/documents/307766
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