Lytvyak, E.

Screening for Carbapenemase-Producing Organisms (CPO) Carriage Can Be Initiated at 6 Months After the Initial Diagnosis of Intestinal Colonization
Lytvyak, E., Trepanier, K., Doroshenko, A., Chandran, A.

The natural course of intestinal colonization with CPO is unknown, but carriage may persist for years. Standardized re-screening criteria are currently not available. We aimed to (1) perform a review of the evidence-based literature; (2) compare proportions of CPO-colonized individuals at various timepoints after the initial diagnosis of intestinal colonization; and (3) estimate a predictive value of remaining colonized at those timepoints.

PubMed, EMBASE, Web of Science, and Cochrane Library (January 2000 to August 2018) were searched. Randomized-control trials, retrospective and prospective cohort, case series and cross-sectional studies were included. The primary outcomes were proportions of patients who remained CPO-colonized at 1, 3, 6, 9 and 12 months. Mean proportions (μ±SD) were compared using t-test. Studies with the most complete and homogeneous data were chosen to calculate the predictive value of remaining CPO-colonized at subsequent timepoints versus baseline. Re-colonized patients were removed from the pool. The missing data were replaced based on the proportions of CPO-colonized to compensate for drop-out.

Twenty-five studies were analyzed. Mean proportions of CPO-colonized versus CPO-decolonized individuals differed significantly at 6 (25.0±16.3% versus 75.0±16.3%; p≤0.0001) and 12 months (21.3±13.9% versus 78.7±13.9%; p≤0.0001). There was no difference between the mean proportions of CPO-colonized individuals at 6 and 12 months (25.0±16.3% versus 21.3±13.9%; p = 0.562). Five studies' results were included in the calculation of the predictive value of remaining CPO-colonized at 6 months versus baseline (16.4%; 95% CI: 14.5-18.3%); and at 12 months (13.3%; 95% CI: 11.6-15.1%).

Study findings suggest similar intestinal colonization rates and predictive values of remaining CPO-colonized at 6 and 12 months. These results will enable the development of an evidence-based and justified policy to consider CPO re-screening at 6 months, which promises to be a more patient-centered and cost-effective strategy.