Consequently, from patients who were at risk according to the universal risk assessment, two types of cultures were taken: risk-based cultures and universal screening cultures as part of the MOVE study. Microbiological methods Risk-based screening samples (i.e. nasal, throat, perineal, and rectal) were taken with cotton swabs. Nasal, throat, and perineal samples were screened for the presence of MRSA; rectal samples for vancomycin-resistant Enterococcus faecium (VRE), multidrug-resistant Pseudomonas spp., multidrug-resistant Acinetobacter calcoaceticus-baumannii complex (A. baumannii), extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales (ESBLE), and carbapenemase-producing Enterobacterales (CPE). Presence of these MDRO was determined using standard microbiological procedures (Supplementary file 2). Universal screening samples, both nasal and perianal, were taken with flocked swabs (Copan Italia, Brescia, Italy). Nasal samples were screened for MRSA, and perianal samples were screened for VRE, highly resistant P. aeruginosa, highly resistant A. baumannii, CPE, and ESBL-E using standard microbiological procedures (Supplementary file 2). Whole genome sequencing (WGS) was performed on all isolates identified through universal screening to identify the presence of antimicrobial resistance genes (Supplementary file 2). Also, multi locus sequence types (MLST) were inferred from the WGS data. In case of discrepancy between WGS and phenotypic ESBL detection, the phenotypic test result was used, to mimic best the standard-of-care. Data collection and analysis Patient data, including results from the universal risk assessment and risk-based screening, and installed isolation measures, were retrospectively collected from the EHR. Additionally, data on admission specialization was collected. Admission specializations were categorized into surgical, medical, hematological or ICU admissions (12). Descriptive analyses were performed, and the yield of screening strategies were compared using Fisher’s exact test using IBM Statistical Package for the Social Sciences Solutions (SPSS) version 28 (IBM Corp., Armonk, New York, USA). Data was processed pseudonymized, AS and AV had access to information that could identify individual patients. Results Universal screening In total, 1069 admission cultures were taken from 1017 patients (Figure 1). Forty-eight (4.7%) patients were admitted more than once, 44 patients were admitted twice and four patients three times. Only a nasal sample was taken for 109 (10.2%) admissions of 109 patients, and only a perianal sample was taken for seven patients (Figure 1). The median age upon admission was 61 (range 18-90). Forty-four (4.1%) cultures of 42 patients were positive for MDRO (Figure 1), 43 (4.5%) perianal cultures were positive for ESBL-E and one 2 81 Comparing universal screening and universal risk-assessment for MDRO
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