Further question on ESBL

Question

Hello,

Recently there was a question and answer on ESBL e.coli. Both our children have CF and keep having germs with ESBL feature again and again, which have not caused any clinical problems so far. Now, however, a planned rehabilitation measure was cancelled on short notice because of this germ, since this seems to be in line with an agreement among the rehabilitation clinics.

Is there a consensus on the evaluation of ESBL e.coli and ESBL klebsiella? Do these have to be considered “problem germs” even when they are clinically inconspicuous?

Greetings.

Answer

Hello,

ESBL (“Extended Beta Lactamase”) producing e.coli and klebsiella spp. are strains with an above-average resistance to antibiotics (i.e. an ESBL involves resistance against almost all beta lactams, ranging from the various penicillin derivates to group 3 cephalosporins with a wide spectrum of activity such as ceftazidime). This limits the choices of antibiotics for patients with an ESBL producer considerably (alternatives include other substances such as carbapenems or fluochinolones). The medical significance of ESBL-positive germs ranges from harmless colonization of the patient to life-threatening infections. In contrast to infections, colonization does not require antibiotics therapy, but it usually calls for adherence to certain hygienic measures.

Just like MRSA, ESBL-positive e.coli or klebsiella spp. therefore have a certain significance as causes of infection and hygiene-relevant (hospital) germs. According to the current German Infection Protection Act [Infektionsschutzgesetz / IfSG, §23], such germs are to be treated, just like MRSA, as germs with special antibiotics resistance, and are subject to specific documentation and evaluation obligations on the part of the hospitals. Usually an infection is preceded by colonization; therefore, in order to protect other patients, one tries to avoid human-to-human transmission by abiding to hygiene measures.

National or international approaches to the hygiene management with ESBL producers or MRSA are not entirely standardized because the risk of transmission of possible consequential infections depends on several factors. In Germany, there are relatively concrete recommendations from the Robert Koch Institute on hygiene in the management of MRSA carriers, since the connection between colonization and severe infections e.g. in the context of hospital stays is beyond dispute. Concerning ESBL producers, the required hygiene measures are less clearly outlined, although many hospitals proceed in a way similar to MRSA carriers, for instance by isolating ESBL carriers in single rooms. The risk of transmission and consequential infection by ESBL producers mostly depends on the carrier’s type of colonization (e.g. respiratory tracts > intestine) and the predisposition of the contact persons (e.g. intensive care unit > regular ward). Ultimately, it is up the director or hygiene representative of a clinic or other communal facility to lay down the measures to avoid transmissions and consequential infections in a hygiene plan depending on the patients treated there as well as on the local conditions.

Kind regards,
Michael Hogardt

30.08.2011