Summary
Background
Extended-spectrum beta-lactamase-producing Enterobacterales (eESBL) have high prevalence
in hospitals, but real-time monitoring of nosocomial acquisition through conventional
typing methods is challenging. Moreover, patient-to-patient transmission varies between
the main species, namely Escherichia coli and Klebsiella pneumoniae, which draws into question the relevance of applying identical preventive measures.
Aim
To detect eESBL cross-transmission events (CTEs) using the quantitative antibiogram
(QA) method in combination with epidemiological data (combined QA method), and to
determine the effectiveness of standard or contact precautions for eESBL species.
Methods
First, a validation set was used to compare the relevance of the combined QA method
with a combination of pulsed-field gel electrophoresis and epidemiological data (combined
PFGE method). Next, a 4-year retrospective analysis was conducted to detect eESBL
CTEs in hospitalized patients. Two species were screened – ESBL E. coli (ESBL-Ec) and ESBL K. pneumoniae (ESBL-Kp). During the study, standard precautions alone were applied to patients
with ESBL-Ec, whereas contact precautions were applied for patients with ESBL-Kp.
Findings
As a proof of concept, use of the combined QA method and the combined PFGE method
for the detection of CTEs gave identical results for E. coli, and similar results for at least 75% of K. pneumoniae. Overall, 722 patients with ESBL-Ec isolates and 280 patients with ESBL-Kp isolates
were included in the retrospective analysis. Nine and 23 CTEs were identified for
E. coli and K. pneumoniae, respectively, involving 20 (2.7%) and 36 (12.8%) patients, respectively.
Conclusion
The combined QA method constitutes a rapid tool for epidemiological surveillance to
detect CTEs. In the study hospital, standard precautions are sufficient to prevent
acquisition of ESBL-Ec, whereas contact precautions must be implemented to prevent
acquisition of ESBL-Kp.
Keywords
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Article info
Publication history
Published online: March 12, 2023
Accepted:
January 24,
2023
Received:
December 16,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
