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

作者：de Celles Matthieu Domenech^*; Zahar Jean Ralph; Abadie Veronique; Guillemot Didier

来源：BMC Infectious Diseases, 2013, 13(1): 187.

DOI：10.1186/1471-2334-13-187

• ESBL-E
• Healthcare epidemiology
• Bacterial pathogens
• Mathematical modeling
• Statistical inference

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. %26lt;br%26gt;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. %26lt;br%26gt;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. %26lt;br%26gt;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.

• 出版日期2013-4-24