Screening: challenging implementation in hospitals
A new screening strategy was intended to identify carriers of multiresistant enterobacteria in hospitals more quickly. Unfortunately, it proved ineffective in practice.
Project description (completed research project)
Enterobacteria that are resistant to a large number of antibiotics due to their ability to produce ESBL and/or carbapenemase impose a substantial financial burden on hospitals. Affected patients are often recognised too late or kept in isolation too long due to incorrect suspicions. Current diagnostic methods for detecting such pathogens are based on bacterial cultures and require at least 48 hours before test results are available.
Combination of two tests
Researchers at Geneva University Hospital therefore developed and tested an accelerated screening strategy. This strategy was intended to speed up decisions on patients’ treatment and on whether or not they needed to be put into isolation. The new approach used the LAMP test trialled at Geneva University Hospital, which is capable of rapidly identifying the most common multiresistant enterobacteria. The LAMP test was supplemented by a new molecular test that specifically identifies the common antibiotic-resistant E. coli strain ST 131. To test the effectiveness of the new strategy, the research group trialled the new method in the intensive care unit over 12 months and compared the results with traditional screening.
Results not sufficiently reliable
The analysis showed that the tests used did not provide sufficiently reliable evidence to take specific protective measures on this basis. It also did not accelerate the assessment of measures that had already been taken, so that these could be possibly be stopped early. Accordingly, the new screening also had no effect on the transmission rate of resistant enterobacteria in the intensive care unit. The researchers maintain that in principle, faster tests could still enable considerably faster screening and, as a result, a significant reduction in costs. In their project, however, methods and processes that would be suitable for an intensive care unit setting were not yet clearly identified.
An interventional study to evaluate the impact of a rapid screening strategy in improving nosocomial ESBL and CPE control in critically ill patients