ESBL (Extended-Spectrum Beta-Lactamase)

Question

My daughter (6 years old) is suffering from CF, her grand-grandmother has spent a long time in hospital, as her leg had been amputated. Now she is discharged home, but she has been diagosed of ESBL (Extended-Spectrum Beta-Lactamase), which should stay like this. She has had MRSA, too, however, it has gone away again. Do the same measures apply to ESBL as to MRSA? We were not allowed to have any contact to the grand-grandmother, and we were not allowed to have any contact to persons who had had contact to her, either. That means that we had been isolated from the family.

Answer

Dear questioner,
many thanks for your question, which mentions an important hygienic problem.
Your 6-year-old daughter is suffering from CF. Patients with CF have an increased risk of suffering from infections of the airways. As clearing of the airways in CF patients does not function properly, the doctor is forced to prescribe antibiotics frequently, in order to fight bacterial germs in the lung.
The grand-grandmother of your daughter had to be operated in hospital. In bacteriological investigations, ESBL (Extended-Spectrum Beta-Lactamase) germs have been detected. Bacteria, which produce ESBL, are capable of inactivating nearly all beta-lactam antibiotics. Beta-lactam antibiotics belong to the most important drugs, which are used for the treatment of CF-typical germs. Unfortunately, the ESBL-resistance genes are located on movable genetic ferries in the bacteria, that means that the resistances can be interchanged between bacteria. Therefore, the ESBL-genes can be transferred to CF-typical germs such as Haemophilus influenzae or Pseudomonas aeruginosa. ESBL-positive germs can be faught only with some few reserve-antibiotics.
As long as the grand-grandmother stays ESBL-positive, your daughter should not have any contact to her grand-grandmother. This contact barrier can only be abolished when 3 control swabs (e.g. rectal swab in case of colonization of the bowel) do not show a finding of ESBL.
ESBL-positive patients as the grand-grandmother of your daughter are reservoirs of germs for the spreading of ESBL-stems. The transfer happens via direct contact, mainly the hands. In case a member of your family needs to visit the grand-grandmother of your daughter due to urgent reasons, the visitor of the grand-grandmother must disinfect his hands intensively at the end of the visit (at leat 3 times with each time at least 2ml over at least 90 seconds rubbing a disinfectant as Sterilium in his hands). Before the visitor is again entering your appartment, where your 6-year old daughter is living, he should repeat the disinfection of the hands.
The hygienic measures are as strong for ESBL as for MRSA. Thereby there is a greater health risk for CF patients in case of ESBL positive germs than in case of MRSA staphylococci due to the higher risk of transfer to the CF-specific germs.
The grand-grandmother will have apprehension for her grand-granddaughter not being able to visit her due to the risk of infection.
Yours sincerely,
Dr. Burkhard Tümmler, Medical School Hannover

05.05.2009