(0.1%) nasal culture was positive for MRSA. The majority of identified ESBL-E were Escherichia coli (74.4%) (Figure 1). Six (13.6%) cultures of six patients were taken from known carriers according to their EHR, and were thus cared for in isolation. For one of 44 (2.2%) admissions, the patient was labelled as a carrier of Citrobacter freundii and Enterobacter cloacae in the EHR, both ESBLproducing, but identified as an unknown ESBL-producing Klebsiella pneumoniae carrier through the universal screening and thus considered as newly identified. This patient was included twice, and twice identified as a carrier of a previously unknown MDRO. Consequently, 38 out of 1069 (3.6%) admission cultures from 37 out of 1017 (3.6%) patients identified unknown carriers at the moment of hospitalization, all ESBL-E carriers. For 26 (2.4%) admissions of 26 patients, MDRO were identified from the cultures, although patients were labelled as MDRO carrier in the EHR. Through universal screening, no carriers of VRE, CPE, highly resistant P. aeruginosa or –A. baumannii were identified. The result of WGS are presented in Supplementary file 3. Figure 1. Flowchart of universal screening and universal risk assessment, with screening results. Universal risk assessment combined with risk-based screening The risk assessment was performed for 946 (88.5%) admissions of 900 individual patients (Figure 1). For 107 (10.0%) admissions, no risk assessment could be found in the EHR. Additionally, for 16 (1.7%) admissions, the EHR referred to a previous screening, but no previous screening was found (Figure 1). Risk factors for MDRO including the specific risk factors for MRSA were present at 19 (2.0%) admissions (Figure 1). Eleven patients were known carriers from which cultures were recently taken, and thus no screening cultures were taken, but patients were placed in isolation. For two (10.5%) admissions, risk-based screening was not performed, although risk factors were present; one patient was a roommate of or caregiver for a MRSA carrier, and one patient had been hospitalized abroad. 82 Chapter 2.3
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