Download Fact Sheet on ESBLs - Hamilton Health Sciences

Fact Sheet on ESBLs
(Extended Spectrum Beta Lactamase producing Bacteria)
WHAT ARE THEY?
These are plasmid-mediated enzymes carried in gram negative
bacteria that are capable of breaking down broad spectrum 
lactam antibiotics such as cefotaxime, ceftriaxone, and ceftazidime.
These third generation cephalosporins were designed to be highly
active against gram-negative bacteria because they were initially
unaffected by all known plasmid encoded -lactamase enzymes.
The bacteria have now found a way to overcome these drugs. The
most common organisms with these ESBL enzymes are e. coli and
klebsiella species, which are part of the normal intestinal flora.
WHY DO THEY CAUSE CONCERN?
The plasmids present in these bacteria have the ability to share
their resistance genes with other Gram negative organisms.
Although klebsiella and e. coli are the most frequently isolated
ESBL carriers the plasmids may infect other bacteria causing them
to become resistant. The cephalosporins are the most commonly
used group of antibiotics and are often used to treat patients with
serious infections even before the infecting organism is known. If
these antibiotics are no longer available, the treatment options for
serious intra-abdominal infections becomes severely limited.
HOW ARE THEY SPREAD?
It is believed that ESBLs are spread in the same manner as VRE
and MRSA (on the hands of personnel from infected or colonized
patients). Because of this we are treating all patients with antibiotic
resistant organisms (AROs) in the same manner. These patients
are placed in contact precautions and must remain there until they
have had three negative sets of cultures. Cultures for ESBLs will be
a weekly rectal swab and when this becomes negative a swab from
any other site previously noted to be positive i.e. abdominal wound.
PREVENTION OF TRANSMISSION
Approaches to the management of antibiotic resistant organisms
vary widely. This is due in part to the lack of scientific evidence
establishing the efficacy of specific control measures. As a result,
the recommendations for WLMH are based on general infection
control principles, review of the literature, the individual’s risk of
transmitting infection, the immunity of adjacent patients, and the
epidemiology of ESBLs at WLMH. If standard precautions are
practiced consistently the risk of transmission of many pathogens,
even when not identified, will be reduced.
Recommended practices to reduce the risk of transmission
include:
 The use of contact precautions ( gown and gloves) when caring
for patients with an ARO
 Patient and family instruction in handwashing hygiene and how to
contain secretions, if applicable.
Placement in a private room is preferred especially in the
following situations:
 When body substances are difficult to contain, due to the volume
and /or the patient's limited adherence to good hygiene.
 When adjacent patients have had recent surgery or are
immunocompromised.
MORE QUESTIONS?
Contact Infection Prevention Services – Ext. 242