Surveillance of extended-spectrum β-lactamase-producing bacteria and routine use of contact isolation: experience from a three-year period

• Published in: The Journal of hospital infection Vol. 66; no. 1; pp. 46 - 51
• Main Authors: Kola, A, Holst, M, Chaberny, I.F, Ziesing, S, Suerbaum, S, Gastmeier, P
• Format: Journal Article
• Language: English
• Published: Kent Elsevier Ltd 01-05-2007; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; beta-Lactam Resistance; beta-Lactamases - metabolism; Biological and medical sciences; Child; Child, Preschool; Contact isolation precautions; Cross Infection - epidemiology; Cross Infection - prevention & control; Enterobacteriaceae; Enterobacteriaceae - classification; Enterobacteriaceae - enzymology; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - drug therapy; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - prevention & control; Escherichia coli; Extended-spectrum β-lactamase; Female; General aspects; Germany; Hospitals, University - statistics & numerical data; Human infectious diseases. Experimental studies and models; Humans; Immunocompromised Host; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infant; Infant, Newborn; Infection Control - methods; Infectious Disease; Infectious diseases; Klebsiella pneumoniae; Male; Medical sciences; Middle Aged; Patient Isolation - methods; Patient-to-patient transmission; Proteus mirabilis; Sentinel Surveillance; Germany; Patient-to-patient transmission; Contact isolation precautions; Extended-spectrum β-lactamase; Human; Immunopathology; Nosocomial infection; Escherichia coli; Transmission; Immune deficiency; Pulsed field electrophoresis; Treatment; Surveillance; Bone marrow; Bacteria; Isolation; Proteus mirabilis; Klebsiella pneumoniae; Public health; Enterobacteriaceae
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2007.01.006

Summary The usefulness and applicability of isolation precautions were questioned for extended-spectrum β-lactamase (ESBL)-producing strains of Enterobacteriaceae in the endemic setting. We performed a surveillance programme for ESBL-positive organisms and the infection control management of patients colonized or infected with these organisms. Between 1 January 2002 and 31 December 2004, a total of 147 cases of ESBL-producing strains of Escherichia coli , Klebsiella pneumoniae and Proteus mirabilis from 123 patients were noted. The overall incidence of ESBL-producing-strain-positive cases was 0.12/1000 patient-days. The proportion of referred cases was 35% ( N = 51); 65% of cases ( N = 96) were acquired in our institution. Infections developed in 57 cases (38.8%), of which 36 (63.3%) were nosocomial. Contact isolation precautions were carried out for 79.6% of the cases, with a median duration of contact isolation precautions for 14 days (range: 0–144). The contact isolation precautions resulted in 2985 isolation days in total, i.e. 995 isolation days per year. Typing by pulsed-field gel electrophoresis showed clonal diversity in 94.2% of the isolates from patients. Seven patient-to-patient transmissions were noted. Only in 10 cases (6.8%) was colonization with ESBL-producing strains cleared. Considering the large number of immunocompromised patients treated in our institution (>1500 bone marrow or solid organ transplantations performed during 2002–2004), we will continue to isolate patients who are colonized or infected with ESBL-producing organisms.