Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing Enterobacteriaceae in a university hospital

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) were isolated from clinical specimens from 130 to 140 patients/year in 1989-199 1 in our hospital. In February 1992, a control program was initiated: scree ning tests in 3 intensive care units (ICUs) and contact-isolation precautio ns in all units. The septic surgical unit served as an isolation ward for s urgical patients from whom ESBLPE was isolated. In 1992, the incidence of E SBLPE acquisition failed to decrease, and most acquisitions occurred in 3 I CUs. Critical evaluation of implementation of isolation procedures in these ICUs prompted corrective measures for barrier precautions. The incidence o f acquired cases subsequently decreased, and a second evaluation determined that these measures had been correctly applied. The incidence of acquired cases in the septic surgical unit was lower than those in the other units. Decreases were also found in the incidence of acquisition of other hand-tra nsmitted multidrug-resistant organisms. Barrier precautions, screening test s for ICU patients, and grouping of cohorts after ICU discharge are effecti ve in controlling the spread of multidrug-resistant microorganisms by cross -contamination, The outbreak was effectively controlled without restricting antimicrobial use.