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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

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

Published: 24 April 2013



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.


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.


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.


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.

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