Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant micro-organisms in a Dutch tertiary care centre

D van Hout; P C J Bruijning-Verhagen; H E M Blok; A Troelstra; M J M Bonten

doi:10.1016/j.jhin.2020.12.007

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant micro-organisms in a Dutch tertiary care centre

J Hosp Infect. 2021 Mar:109:32-39. doi: 10.1016/j.jhin.2020.12.007. Epub 2020 Dec 24.

Authors

D van Hout¹, P C J Bruijning-Verhagen², H E M Blok³, A Troelstra³, M J M Bonten⁴

Affiliations

¹ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Electronic address: D.vanHout-3@umcutrecht.nl.
² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
³ Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁴ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands; Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.

PMID: 33347938
DOI: 10.1016/j.jhin.2020.12.007

Abstract

Background: In Dutch hospitals a six-point questionnaire is currently mandatory for risk assessment to identify carriers of multidrug-resistant organisms (MDROs) at the time of hospitalization. Presence of one or more risk factors is followed by pre-emptive isolation and microbiological culturing.

Aim: To evaluate the yield of the universal risk assessment in identifying MDRO carriers upon hospitalization.

Methods: A cross-sectional study was performed using routine healthcare data in a Dutch tertiary hospital between January 1^st, 2015 and August 1^st, 2019. MDRO risk assessment upon hospitalization included assessment of: known MDRO carriage, previous hospitalization in another Dutch hospital during an outbreak or a foreign hospital, living in an asylum centre, exposure to livestock farming, and household membership of a meticillin-resistant Staphylococcus aureus carrier.

Findings: In total, 144,051 admissions of 84,485 unique patients were included; 4480 (3.1%) admissions had a positive MDRO risk assessment. In 1516 (34%) admissions microbiological screening was performed, of which 341 (23%) yielded MDRO. Eighty-one patients were categorized as new MDRO carriers, as identified through MDRO risk assessment, reflecting 0.06% (95% confidence interval: 0.04-0.07) of all admissions and 1.8% (1.4-2.2) of those with positive risk assessment. As a result, the number of 'MDRO risk assessments needed to perform' and individual 'MDRO questions needed to ask' to detect one new MDRO carrier upon hospitalization were 1778 and 10,420, respectively.

Conclusion: The yield of the current strategy of MDRO risk assessment upon hospitalization is limited and it needs thorough reconsideration.

Keywords: Carriage; Epidemiology; MDRO; Multidrug-resistant organism; Screening; Surveillance.

MeSH terms

Carrier State / diagnosis*
Cross-Sectional Studies
Drug Resistance, Multiple, Bacterial*
Hospitalization
Humans
Mass Screening*
Methicillin-Resistant Staphylococcus aureus*
Netherlands
Risk Assessment*
Tertiary Care Centers