To check or not to check. Rectal ESBL colonization in hospitalized elderly patients

Galina Goltsman, Yehuda Baumohl, Gilad Gal, Zvi Buckman, Valery Proshkin, Emily Lubart

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The worldwide spread of extended-spectrum-beta-lactamase (ESBL) producing bacteria has affected health care. ESBL confers resistance to the majority of beta-lactam antibiotics. Materials and Methods: We intended to quantify the rates of rectal ESBL-positive and negative patients that eventually developed fever and urinary tract infection (UTI). All rectal ESBL-positive patients were to be initially treated with the conventional antibiotics that have anti-ESBL activity (amikacin or ertapenem), while ESBL-negative patients were given ceftriaxone. Results: Most patients were rectal ESBL-positive (60.7%). Fever was in 51% patients; 67.8% of them developed signs and symptoms of UTI. Most patients with UTI were urinary ESBL-positive (79%), most rectal ESBL-negative patients were urinary ESBL-negative (75%), (χ2 = 18.5, df = 1, P <.001). Overall mortality was higher in the febrile group (39, 34.8%) versus the afebrile (1, 0.9%) (χ2 = 42, df = 1, P <.001). The mortality rate in the febrile group was significantly higher in the rectal ESBL-positive patients (χ2 = 7.5, df = 1, P =.006). Discussion: The direct correlation of rectal ESBL-positive and negative and respectively urinary ESBL-positive and negative patients’ advocate for the use of antibiotics with anti-ESBL activity as an empiric treatment of rectal ESBL-positive patients with suspected UTI. Conclusion: In our opinion, it is worthwhile to identify rectal ESBL-positivity on hospital admission.

Original languageEnglish
Pages (from-to)1236-1239
Number of pages4
JournalAmerican Journal of Infection Control
Volume46
Issue number11
DOIs
StatePublished - Nov 2018

Keywords

  • Empiric antibiotic choice
  • Rectal ESBL colonization
  • Urinary tract infection

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