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Limits of patient isolation measures to control extended-spectrum beta-lactamase-producing Enterobacteriaceae: model-based analysis of clinical data in a pediatric ward

Abstract : Background
Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are a growing concern in hospitals and the community. How to control the nosocomial ESBL-E transmission is a matter of debate. Contact isolation of patients has been recommended but evidence supporting it in non-outbreak settings has been inconclusive.
Methods
We used stochastic transmission models to analyze retrospective observational data from a two-phase intervention in a pediatric ward, successively implementing single-room isolation and patient cohorting in an isolation ward, combined with active ESBL-E screening.
Results
For both periods, model estimates suggested reduced transmission from isolated/cohorted patients. However, most of the incidence originated from sporadic sources (i.e. independent of cross-transmission), unaffected by the isolation measures. When sporadic sources are high, our model predicted that even substantial efforts to prevent transmission from carriers would have limited impact on ESBL-E rates.
Conclusions
Our results provide evidence that, considering the importance of sporadic acquisition, e.g. endogenous selection of resistant strains following antibiotic treatment, contact-isolation measures alone might not suffice to control ESBL-E. They also support the view that estimating cross-transmission extent is key to predicting the relative success of contact-isolation measures. Mathematical models could prove useful for those estimations and guide decisions concerning the most effective control strategy.
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Journal articles
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https://hal-pasteur.archives-ouvertes.fr/pasteur-00819438
Contributor : Ed. Bmc <>
Submitted on : Wednesday, May 1, 2013 - 12:53:12 PM
Last modification on : Friday, October 23, 2020 - 4:33:18 PM
Long-term archiving on: : Friday, August 2, 2013 - 4:05:18 AM

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Citation

Matthieu Domenech de Cellès, Jean-Ralph Zahar, Véronique Abadie, Didier Guillemot. Limits of patient isolation measures to control extended-spectrum beta-lactamase-producing Enterobacteriaceae: model-based analysis of clinical data in a pediatric ward. BMC Infectious Diseases, BioMed Central, 2013, 13 (1), pp.187. ⟨10.1186/1471-2334-13-187⟩. ⟨pasteur-00819438⟩

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