Email updates

Keep up to date with the latest news and content from BMC Infectious Diseases and BioMed Central.

Open Access Research article

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

Matthieu Domenech de Cellès1237*, Jean-Ralph Zahar45, Véronique Abadie456 and Didier Guillemot1278

Author Affiliations

1 Unité de Pharmacoépidémiologie et Maladies Infectieuses, Institut Pasteur, Paris, France

2 U657, Inserm, Paris, France

3 Paris 6: Univ. Pierre et Marie Curie, Cellule Pasteur UPMC, Paris, France

4 Unité d’hygiène hospitalière, Service de microbiologie, CHU Necker-Enfants Malades, Paris, France

5 Université Paris Descartes, Paris, France

6 Service de Pédiatrie générale, CHU Necker-Enfants Malades, Paris, France

7 EA 4499, Université de Versailles–Saint-Quentin-en-Yvelines, Versailles, France

8 Unité Fonctionnelle de Santé Publique, Hôpital Raymond-Poincaré, Assistance Publique–Hôpitaux de Paris, Garches, France

For all author emails, please log on.

BMC Infectious Diseases 2013, 13:187  doi:10.1186/1471-2334-13-187

Published: 24 April 2013

Abstract

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.

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.

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.

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.

Keywords:
ESBL-E; Healthcare epidemiology; Bacterial pathogens; Mathematical modeling; Statistical inference