Lytvyak, E.

Creation of an evidence-based background for developing a comprehensive scoring system for targeted admission screening for colonization with carbapenemase-producing organisms (CPO)
Lytvyak, E., Trepanier, K., Doroshenko, A., Chandran, A.

Identification of CPO carriers at admission is critical for hospital transmission risk mitigation; however, no standardized cohesive approach exists for admission screening practices. Our objectives were to (1) review available literature; (2) collect and appraise criteria recommended by various studies/organizations to identify the greatest at-risk population; (3) create an evidence-based background for developing a comprehensive scoring system for targeted admission screening.

PubMed, EMBASE, Web of Science, and Cochrane Library (January 2000 to August 2018) were searched. Retrospective and prospective cohort and case-control, cross-sectional studies, reviews, local, regional and international guidelines were included. The criteria identified were categorized into three main clusters: health care interaction (international, domestic hospitalizations, procedures, transfers, etc.), epidemiological (high-risk unit admission, contact with CPO, etc.) and individual (history of CPO, health status, immunosuppression, etc.) factors. Frequencies of various criteria appearing in the literature were calculated.

Twenty studies from 10 different countries with various CPO endemicity levels were analyzed. Three studies (15%) utilized criteria from all three clusters. Health care interaction factors only were used by 5 studies (25%), epidemiological factors only by 3 (15%), and individual factors only by 4 (20%). Two studies (10%) concluded that CPO admission screening is not needed at all. The most common criteria used were international hospitalization within the last 12 months (n=9, 45%), previously receiving care in/transferred from CPO-prevalent areas/facilities (n=6, 30%), and current admission to a high-risk unit (n=5, 25%). A risk scoring system was proposed based on these factors.

Criteria for CPO admission screening vary considerably across jurisdictions with different CPO endemicity. Assigning criteria with different weights and ranks, correlation with local epidemiological patterns and individual test results, and further development and subsequent validation of a comprehensive scoring system will help to most accurately identify the greatest at-risk population and develop policy for targeted screening.