title: Contact Precautions for Preventing Nosocomial Transmission of Extended-Spectrum β Lactamase-Producing Escherichia coli: A Point/Counterpoint Review.
abstract: Contact precautions have been recommended for hospitalized patients colonized or infected with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC). Despite such recommendations, a steady, worldwide increase of ESBL-EC has been reported. We discuss arguments in favor of and against contact precautions for ESBL-EC carriers. Healthcare settings with high ESBL-EC colonization pressure, extended hospital stay, and close contact between patients may serve as amplification platforms, further accelerating transmission. However, the evidence base for justifying the implementation of contact precautions for all ESBL-EC carriers remains weak. Until more high-level evidence is available, we support the attitude that hospitals and countries should carefully evaluate their decision on whether to implement contact precautions for ESBL-EC carriers. It is likely that a majority of patients and wards do not need to rely on contact precautions for preventing nosocomial ESBL-EC transmission in nonepidemic settings, without harming patient safety, providing sufficient compliance with standard precautions and ongoing surveillance.
authors.affiliation: Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Switzerland.
authors.forename: Sarah
authors.initials: S
authors.lastname: Tschudin-Sutter
authors.affiliation: Infection Control Program, Bichat University Hospital, Paris, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
authors.affiliation: Heidelberg University Hospital, Department of Infectious Diseases.
authors.forename: Nico T
authors.initials: NT
authors.lastname: Mutters
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine I, German Center for Infection Research (DZIF), Tübingen University Hospital,Germany.
authors.forename: Evelina
authors.initials: E
authors.lastname: Tacconelli
authors.affiliation: Infection Control Unit, Microbiology Department, Avicenne Hospital, Paris-Nord University (UHR SMBH), Bobigny, France.
authors.forename: Jean Ralph
authors.initials: JR
authors.lastname: Zahar
authors.affiliation: Infection Control Programme, Geneva University Hospitals and Medical School, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D004926:Escherichia coli / Q000187:drug effects / Q000201:enzymology / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D005260:Female; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases
keywords: ESBL-EC; ESBL-producing Escherichia coli; contact precautions; nosocomial transmission