title: Disparity in infection control practices for multidrug-resistant Enterobacteriaceae.
abstract: BACKGROUND
  There is a lack of empiric evidence regarding the optimal approach to controlling the transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and carbapenem-resistant Enterobacteriaceae (CRE). In this context, we expect that infection control practices for these organisms vary widely between hospitals.
  
  
  METHODS
  A survey examining infection control practices for ESBL-E and CRE was distributed to 6 academic and 9 community hospitals in Toronto, Canada.
  
  
  RESULTS
  All hospitals responded to the survey. Among 15 hospitals in 1 geographic area, 8 different approaches to the management of ESBL-E were utilized. There was wide variation in the use infection control practices including admission screening (53% and 53%), contact precautions (53% and 100%), and isolation (60% and 100%) for ESBL-E and CRE, respectively. Of hospitals performing admission screening, 75% used risk factor-based screening for ESBL-E and CRE.
  
  
  CONCLUSIONS
  Even within a single geographic area, there is wide variation in infection control strategies to contain or control ESBL-E and CRE. These results are concerning given evidence that a coordinated approach may be required to prevent or limit the emergence of CRE.
authors.affiliation: Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lowe
authors.forename: Kevin
authors.initials: K
authors.lastname: Katz
authors.forename: Allison
authors.initials: A
authors.lastname: McGeer
authors.forename: Matthew P
authors.initials: MP
authors.lastname: Muller
mesh_terms: D002170:Canada / Q000453:epidemiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000517:prevention & control*; D006302:Health Services Research; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control / Q000379:methods*