Rapid near-patient screening for active surveillance of carbapenemase-producing Enterobacterales at admission in a long-term acute care rehabilitation hospital: a 4-year experience in a high-endemicity setting.

BACKGROUND

Carbapenemase-producing Enterobacterales (CPE) pose significant risks in healthcare settings, including long-term acute care rehabilitation hospitals (LTACRHs). This study investigated the impact of implementation of a near-patient rapid diagnostic test (NP-RDT) for active surveillance of CPE carriage at admission in an LTACRH from a setting with high CPE endemicity.

METHODS

An NP-RDT for CPE detection in rectal swabs was implemented in conjunction with remote validation of results by a clinical microbiologist. Outcomes were monitored over a 4-year period (January 2020-December 2023). The primary outcome was the incidence of CPE colonization acquired during hospital stay, monitored by periodic surveillance of inpatients who tested negative at admission. Secondary outcomes included direct and indirect costs related to active surveillance, infection prevention and control practices (gloves, gowns, face masks and extra nursing time), and concordance between the NP-RDT and the conventional culture method.

RESULTS

CPE screening with the NP-RDT was carried out on 62.7% of patients for whom no information on carriage was available at admission (2387/3808), with an increasing trend in adherence over time. The CPE carriage rate at admission was 16.5% overall and 32.7% among patients admitted to the severe brain injuries (SBI) ward, confirming the very high endemicity of CPE in this setting. The incidence of in-hospital CPE colonization decreased from 6.05 cases/100 at-risk patient-weeks in 2020 to 2.96 cases/100 at-risk patient-weeks in 2023, with a more pronounced reduction in the SBI ward (9.32 cases/100 at-risk patient-weeks in 2020 vs 4.22 cases/100 at-risk patient-weeks in 2023) (P=0.0291, significant). Despite increased screening costs, overall savings of approximately 44,000 € were estimated due to reduced need for pre-emptive patient isolation (-6762 unnecessary pre-emptive isolation days).

CONCLUSIONS

This study underscores that NP-RDT screening at admission could contribute to a reduction in in-hospital CPE cross-transmission while improving resource allocation in LTACRHs in settings with high CPE endemicity.