Infection control implications of extended-spectrum beta-lactamase (ESBL) production by Klebsiellae and other Gram-negative bacteria

Abstract

Extended-spectrum beta-lactamase (ESBL) producing organisms have been detected in Australian hospitals over the last 10 years. They are mostly encountered in very sick patients who have been hospitalised for long periods, particularly in intensive care units (ICUs). Use of invasive medical devices and broad spectrum antibiotics predispose to colonisation and infection with these organisms. Control of epidemic or endemic ESBL producing organisms is possible using a multidisciplinary approach utilising the resources of routine clinical microbiology laboratories, molecular epidemiology laboratories and clinical infection control practitioners. Many hospitals can control ESBL producing organisms using a combination of classical infection control interventions such as contact isolation and modification of antibiotic prescribing practices, in particular restriction of use of third generation cephalosporins.