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Shared patient rooms noninferior to private rooms for halting ESBL transmission
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Kluytmans-van den Bergh
In terms of preventing transmission, isolating patients with extended-spectrum beta-lactamase-producing Enterobacteriaceae on contact precautions in a hospital room with multiple beds is noninferior to isolating them on contract precautions in a private room with one bed, according to a study from the Netherlands published in The Lancet Infectious Diseases.
“Noninferiority of the multiple-bed room strategy could change the current single-bed room preference for isolation of patients with [extended-spectrum beta-lactamase (ESBL)]-producing Enterobacteriaceae and, thus, broaden infection-control options for ESBL-producing Enterobacteriaceae in daily clinical practice,” Marjolein F. Q. Kluytmans-van den Bergh, MD, PhD, from the department of epidemiology at the University Medical Center Utrecht, and colleagues wrote.
The researchers noted that the current role of unprotected ward stay in the nosocomial spread of these bacteria, together with the high frequency of undetected rectal carriage of them in patients during hospitalization, suggest that control measures can be optimized.
Kluytmans-van den Bergh and colleagues sought to determine whether an isolation strategy of contact precautions prevent transmission of ESBL-producing Enterobacteriaceae more effectively in a multiple-bed room or a single-bed room. To do so, they conducted a cluster-randomized, crossover, non-inferiority study on surgical and medical wards at 16 Dutch hospitals. They applied contact precautions — defined as wearing gloves for all direct contacts with the patient or the patient’s immediate belongings and environment — in both room types during two consecutive study periods after randomly assigning hospitals 1:1 by computer to one of the two sequences of isolation. They identified index patients as those with ESBL-producing Enterobacteriaceae cultured from a routine clinical sample. Patients were eligible if they were aged at least 18 years, had a culture result reported within 1 week of culture and, before discharge, had no strict indication for barrier precautions in a single-bed room and had no wardmate infected or colonized with an isolate of the same bacterial species with a similar antibiogram.
Among 463 index patients and 7,093 wardmates included in the per-protocol population, the researchers identified transmission to at least one wardmate for 11 (4%) of 275 index patients during the single-bed room strategy and for 14 (7%) of 188 index patients during the multiple-bed room strategy period (crude risk difference, 3.4%; 90% CI, -0.3 to 7.1).
“The large contribution of [Escherichia] coli to the burden of ESBL supports current Dutch recommendations to target infection-control measures at all ESBL-producing Enterobacteriaceae, including E. coli,” the researchers wrote. – by Joe Gramigna
Disclosures: The authors report no relevant financial disclosures.
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