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Scientific article
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Screening for intestinal carriage of ESBL-producing Enterobacteriaceae in critically ill patients: expected benefits and evidence-based controversies

Publication date2018
Abstract

The rising burden of intensive-care unit (ICU)-acquired infections due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) strengthens the requirement for efficient prevention strategies. The detection of intestinal carriage of ESBL-E through active surveillance cultures (ASC) and the implementation of contact precautions (CP) in carriers are currently advocated in most high-income countries to prevent cross-transmission and subsequent ESBL-E infections in critically ill patients. Yet, recent studies have challenged the benefit of ASC and CP to control the spread of ESBL-E in ICUs with high compliance to standard hygiene precautions and no on-going outbreak of ESBL-producing K. pneumoniae or Enterobacter spp. Besides, given their debated performance to positively predict patients at risk of ESBL-E infections, ASC results appear of limited value to rationalize the empirical use of carbapenems in the ICU, emphasizing the urgent need for novel anticipatory and diagnostic approaches. This Viewpoint article summarizes the available evidence on these issues.

Citation (ISO format)
ZAHAR, Jean-Ralph et al. Screening for intestinal carriage of ESBL-producing Enterobacteriaceae in critically ill patients: expected benefits and evidence-based controversies. In: Clinical Infectious Diseases, 2018. doi: 10.1093/cid/ciy864
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ISSN of the journal1058-4838
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