Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey

Helene Skjøt-Arkil, Christian Backer Mogensen, Annmarie Touborg Lassen, Isik S Johansen, Ming Chen, Poul Petersen, Karen V Andersen, Svend Ellermann-Eriksen, Jørn M Møller, Marc Ludwig, David Fuglsang-Damgaard, Finn Erland Nielsen, Dan B Petersen, Ulrich S Jensen, Flemming S Rosenvinge

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Abstract

OBJECTIVES: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.

DESIGN: Multicentre descriptive and analytic cross-sectional survey.

SETTING: Eight EDs and four clinical microbiology departments in Denmark.

PARTICIPANTS: Adults visiting the ED.

MAIN OUTCOME MEASURES: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.

RESULTS: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.

CONCLUSION: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.

TRIAL REGISTRATION NUMBER: NCT03352167;Post-results.

Original languageEnglish
Article numbere029000
JournalBMJ Open
Volume9
Issue number6
Number of pages10
ISSN2044-6055
DOIs
Publication statusPublished - Jun 2019

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Hospital Emergency Service
Cross-Sectional Studies
Enterobacteriaceae
Bacteria
beta-Lactamases
Methicillin-Resistant Staphylococcus aureus
Oceania
Anti-Bacterial Agents
Urinary Catheters
Denmark
Pharynx
Microbiology
Nose
Rectum
Respiratory Tract Infections
Length of Stay
Age Groups
Demography
Vancomycin-Resistant Enterococci
carbapenemase

Keywords

  • carbapenemase-producing enterobacteria
  • carrier prevalence
  • extended-spectrum beta-lactamase-producing enterobacteria
  • methicillin resistant staphylococcus aureus
  • risk factors
  • vancomycin resistant enterococci

Cite this

Skjøt-Arkil, H., Mogensen, C. B., Lassen, A. T., Johansen, I. S., Chen, M., Petersen, P., ... Rosenvinge, F. S. (2019). Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey. BMJ Open, 9(6), [e029000]. https://doi.org/10.1136/bmjopen-2019-029000
Skjøt-Arkil, Helene ; Mogensen, Christian Backer ; Lassen, Annmarie Touborg ; Johansen, Isik S ; Chen, Ming ; Petersen, Poul ; Andersen, Karen V ; Ellermann-Eriksen, Svend ; Møller, Jørn M ; Ludwig, Marc ; Fuglsang-Damgaard, David ; Nielsen, Finn Erland ; Petersen, Dan B ; Jensen, Ulrich S ; Rosenvinge, Flemming S. / Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments : a cross-sectional survey. In: BMJ Open. 2019 ; Vol. 9, No. 6.
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abstract = "OBJECTIVES: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.DESIGN: Multicentre descriptive and analytic cross-sectional survey.SETTING: Eight EDs and four clinical microbiology departments in Denmark.PARTICIPANTS: Adults visiting the ED.MAIN OUTCOME MEASURES: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.RESULTS: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2{\%}, 95{\%} CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1{\%} (95{\%} CI 0.0 to 0.2), MRSA prevalence was 0.3{\%} (95{\%} CI 0.2 to 0.5), VRE prevalence was 0.4{\%} (95{\%} CI 0.3 to 0.6) and ESBL prevalence was 4.5{\%} (95{\%} CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.CONCLUSION: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.TRIAL REGISTRATION NUMBER: NCT03352167;Post-results.",
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Skjøt-Arkil, H, Mogensen, CB, Lassen, AT, Johansen, IS, Chen, M, Petersen, P, Andersen, KV, Ellermann-Eriksen, S, Møller, JM, Ludwig, M, Fuglsang-Damgaard, D, Nielsen, FE, Petersen, DB, Jensen, US & Rosenvinge, FS 2019, 'Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey', BMJ Open, vol. 9, no. 6, e029000. https://doi.org/10.1136/bmjopen-2019-029000

Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments : a cross-sectional survey. / Skjøt-Arkil, Helene; Mogensen, Christian Backer; Lassen, Annmarie Touborg; Johansen, Isik S; Chen, Ming; Petersen, Poul; Andersen, Karen V; Ellermann-Eriksen, Svend; Møller, Jørn M; Ludwig, Marc; Fuglsang-Damgaard, David; Nielsen, Finn Erland; Petersen, Dan B; Jensen, Ulrich S; Rosenvinge, Flemming S.

In: BMJ Open, Vol. 9, No. 6, e029000, 06.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments

T2 - a cross-sectional survey

AU - Skjøt-Arkil, Helene

AU - Mogensen, Christian Backer

AU - Lassen, Annmarie Touborg

AU - Johansen, Isik S

AU - Chen, Ming

AU - Petersen, Poul

AU - Andersen, Karen V

AU - Ellermann-Eriksen, Svend

AU - Møller, Jørn M

AU - Ludwig, Marc

AU - Fuglsang-Damgaard, David

AU - Nielsen, Finn Erland

AU - Petersen, Dan B

AU - Jensen, Ulrich S

AU - Rosenvinge, Flemming S

PY - 2019/6

Y1 - 2019/6

N2 - OBJECTIVES: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.DESIGN: Multicentre descriptive and analytic cross-sectional survey.SETTING: Eight EDs and four clinical microbiology departments in Denmark.PARTICIPANTS: Adults visiting the ED.MAIN OUTCOME MEASURES: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.RESULTS: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.CONCLUSION: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.TRIAL REGISTRATION NUMBER: NCT03352167;Post-results.

AB - OBJECTIVES: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.DESIGN: Multicentre descriptive and analytic cross-sectional survey.SETTING: Eight EDs and four clinical microbiology departments in Denmark.PARTICIPANTS: Adults visiting the ED.MAIN OUTCOME MEASURES: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.RESULTS: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.CONCLUSION: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.TRIAL REGISTRATION NUMBER: NCT03352167;Post-results.

KW - carbapenemase-producing enterobacteria

KW - carrier prevalence

KW - extended-spectrum beta-lactamase-producing enterobacteria

KW - methicillin resistant staphylococcus aureus

KW - risk factors

KW - vancomycin resistant enterococci

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U2 - 10.1136/bmjopen-2019-029000

DO - 10.1136/bmjopen-2019-029000

M3 - Journal article

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JO - BMJ Open

JF - BMJ Open

SN - 2044-6055

IS - 6

M1 - e029000

ER -