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Unformatted text preview: REVIEW 10.1111/j.1469-0691.2005.01326.x New strategies to identify patients harbouring antibiotic-resistant bacteria at hospital admission E. Tacconelli Department of Infectious Diseases, Catholic University, Rome, Italy and Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA ABSTRACT Nosocomial infections caused by antibiotic-resistant bacteria are associated with high morbidity and mortality worldwide. Most prevention strategies focus on cross-transmission, but the endemic state inside the hospital is also maintained through the influx of patients colonised or infected with antibiotic- resistant bacteria, balanced by the efflux of colonised patients following discharge. Epidemiological research has demonstrated that eradication can be achieved by preventing the influx of resistant bacteria. The presence of a central venous catheter and a history of methicillin-resistant Staphylococcus aureus (MRSA) infection or colonisation are associated significantly with methicillin-resistant staphylo- coccal bacteraemia at admission. Previous antibiotic therapy and transfer from long-term care facilities or nursing homes are associated with bacteraemia caused by methicillin-resistant coagulase-negative staphylococci, while skin ulcer and cellulites are independent risk-factors for MRSA bacteraemia. A scoring system using point values has been developed and validated to identify patients positive for vancomycin-resistant enterococci at admission. Six variables were identified: age > 60 years (2 points); hospitalisation in the previous year (3); use of two or more antibiotics during the previous 30 days (3); transfer from another hospital or long-term care facility (3); a requirement for chronic haemodialysis (2); and a previous history of MRSA infection (4). With a point score cut-off of 10, the specificity of this prediction rule is 98 % . Knowledge of variables identifying patients at high risk for being colonised or infected with antibiotic-resistant bacteria may assist clinicians in targeting preventive measures and streamlining the use of vancomycin. Current studies are analysing risk-factors for harbouring multiresistant Gram-negative bacteria at hospital admission. Keywords Antibiotic resistance, healthcare-associated infections, nosocomial infections, prevention, review, risk- factors Accepted: 17 September 2005 Clin Microbiol Infect 2006; 12: 102109 INTRODUCTION Nosocomial infections pose a significant threat to patients worldwide, with a recent report of 4 % excess mortality for infections associated with medical care, and 23 % mortality for post-opera- tive septicaemia . Most deaths associated with nosocomial infections are caused by antibiotic- resistant bacteria. European surveillance has documented that methicillin-resistant Staphylococ- cus aureus (MRSA), vancomycin-resistant enter- ococci (VRE), and multidrug-resistant Gram- negative bacteria are increasing rapidly in import-...
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