Control of infections due to extended-spectrum β-lactamase-producing organisms in hospitals and the community

Abstract

Control of infection classically involves hand and healthcare hygiene, reduction of selective and ineffective chemotherapy, reduction of invasive procedures and achlorhydria and adequate staffing, along with appropriate containment and concentration of patients. Investigation and control of any continuing sources of infection in food and water supplies is important also, as is recognition of individuals carrying high-risk strains and species. The onset of infection may be distant from the time of acquisition and may critically affect epidemiological assessment of control points. Carriage may be prolonged, increasing the likelihood of recurrent infection and exacerbating the difficulty of control. Mortality associated with resistance is difficult to assess retrospectively and may not be high, complicating analysis of the success or failure of control measures.

Ventriculitis Associated with Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae after Acupuncture

“…Screening is advocated in patients being admitted or transferred from other institutions, including nursing and residential homes [90]. Surveillance of infected and high risk patients is used to either monitor an outbreak or, preferably, prevent one.…”

“…Patients who are infected with such infections should be nursed in a single room, or cohorting may be necessary if such isolation facilities are limited [90].…”

“…This again reinforces the importance of recognising local resistance patterns. An antibiotic policy which takes this into account and restricts the use of broad spectrum agents (especially third-generation cephalosporins) is well recognised as key [28,90,92,93].…”

“…Gastrointestinal surgery, intubation, and urinary catheterisation are all associated with this occurrence [90,94].…”

Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen

“…Für ein risikobasiertes Aufnahmescreening gelten als Risikopatienten Personen, die aus anderen Einrichtungen des Gesundheitswesens übernommen werden [342] In einer französischen Untersuchung wurde die selektive Darmdekontamination zur Eradikation von ESBL-Bildnern (ohne Angaben zur Speziesverteilung) angewandt. Die Behandlung bestand aus zwei der folgenden Antibiotika: Polymyxin E (1,5 Millionen Einheiten), Neomycin (500 mg) oder Erythromycin (500 mg) 4x/Tag.…”