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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