Acquisition of MDR-GNB in hospital settings: a systematic review and meta-analysis focussing on ESBL-E.

Acquisition of MDR-GNB in hospital settings: a systematic review and meta-analysis focussing on ESBL-E.

J Hosp Infect. 2020 Sep 09;:

Authors: Vink J, Edgeworth J, Bailey SL

Abstract
INTRODUCTION: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) and other multi-drug resistant gram-negative bacteria (MDR-GNB) have globally disseminated since their discovery in the late 20th century. Various infection prevention and control measures are in place to prevent nosocomial transmission of these organisms, but their efficacy remains disputed. New literature has emerged in recent years providing further evidence which can be used to formulate effective strategies for tackling this issue in the future.
METHODS: A systematic review was performed to characterise prevalence of colonisation of multi-drug resistant organisms and subsequent acquisition of these organisms within hospital settings. A meta-analysis was performed to characterise prevalence and acquisition of ESBL-E in Europe and North America.
RESULTS: Twenty-eight studies fulfilled the inclusion criteria. E. Coli formed the main burden of MDR-GNB colonisation worldwide. Patient-to-patient transmission of ESBL-E was found to be rare, but increased transmissibility of K. Pneumoniae was described over E.Coli. Within European and North American healthcare settings, a meta-analysis of 8 studies identified a pooled prevalence of ESBL-E on admission to hospital of 7.91%, and acquisition rate of 3.73%.
DISCUSSION: Low prevalence at the point of hospital admission and insufficient evidence of patient-to-patient transmission suggests that infection prevention and control measures such as universal surveillance screening and single-room isolation are unlikely to be practical or effective interventions in reducing the overall burden ESBL-E in hospitals, in line with current European guidelines. We argue instead efforts should be placed on controlling spread of these organisms and other MDR-GNB in the community, predominantly long-term care facilities.

PMID: 32918969 [PubMed - as supplied by publisher]