EXTENDED SPECTRUM BETA-LACTAMASE
Extended Spectrum Beta-Lactamase producing bacteria (ESBLs) represent a class of micro-organisms that have developed resistance to penicillins and all other beta-lactam based antibiotics (except carbapenems and cephamycins) as well as their combination with beta-lactam inhibitors.
These organisms are worldwide in distribution but can vary considerably in different countries. ESBLs include organisms such as Pseudomonas aeruginosa, Serratia marcescens, Klebsiella pneumoniae, Klebsiella oxytoca and E. Coli. ESBLs frequently colonize the lower intestinal tract and have also been found in abscesses, blood, catheter tips, sputum and throat culture.
HOW DOES TRANSMISSION OF ESBLS OCCUR?
Infection by ESBLs is most prevalent in areas where antibiotic use is high or when patients have been exposed to prolonged hospitalization / nursing home care or have been subject to previous antimicrobial therapy.
Transmission of ESBLs can occur via hands but is also capable via inanimate objects. While proper hand hygiene can reduce the rate of transmission, proper control of contaminated surfaces is also required.
Just as with VRE or MRSA, it is likely the ESBLs’ resistance mechanism is independent to the mode of action of hard surface disinfectants such as quaternary ammonium chlorides.
With time ESBLs will be subjected to efficacy testing with disinfectants and they will be specifically listed in product literature just as MRSA and VRE are specifically listed today.
Transmission occurs via hand contact as well as environmental surfaces. ESBLs can be isolated in feces, wounds, blood and bodily fluids. Standard Precautions for these soils and
implementation of Contact Isolation for confirmed ESBL infections can help control the spread of ESBLs within a facility.
WHAT ARE THE BEST STRATEGIES TO PREVENT THE TRANSMISSION OF ESBLs?
Infection Prevention strategies include standards for hand hygiene, personal protective equipment and environmental surface control. Good hand hygiene should include frequent hand washing for the required duration of time and using a quality hand soap. Hand sanitizer should also be used heavily to increase the overall number of hand hygiene events. As hand sanitizer is not effective in the presence of gross soil and certain microbes like C. difficile, revert back to soap and water when dealing with pathogens that are not killed by 70% and higher alcohol-based hand sanitizers. Disinfectants capable of disinfecting and sanitizing objects or surfaces contaminated with vegetative bacteria may be effective against ESBLs for their control on environmental surfaces. “High Level Performance” surface disinfectants such as Complete 6000 and Saber are a reasonable choice as a disinfectant in Contact Isolation situations involving ESBL.