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Risk of Acquiring Extended-Spectrum β-Lactamase–Producing Klebsiella Species and Escherichia coli from Prior Room Occupants in the Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Adebola O. Ajao
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Min Zhan
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Jessina C. McGregor
Oregon State University, Oregon Health and Science University College of Pharmacy, Portland, Oregon
Kerri A. Thom
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Jon P. Furuno*
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Oregon State University, Oregon Health and Science University College of Pharmacy, Portland, Oregon
College of Pharmacy, Department of Pharmacy Practice, 3303 SW Bond Avenue CH12C. Portland, OR 97239 (



To quantify the association between admission to an intensive care unit (ICU) room most recently occupied by a patient positive for extended-spectrum β-lactamase (EBSL)-producing gram-negative bacteria and acquisition of infection or colonization with that pathogen.


Retrospective cohort study.

Setting and Patients.

The study included patients admitted to medical and surgical ICUs of an academic medical center between September 1, 2001, and June 30, 2009.


Perianal surveillance cultures were obtained at admission to the ICU, weekly, and at discharge from the ICU. Patients were included if they had culture results that were negative for ESBL-producing gram-negative bacteria at ICU admission and had an ICU length of stay longer than 48 hours. Pulsed-field gel electrophoresis (PFGE) was performed on ESBL-positive isolates from patients who acquired the same bacterial species (eg, Klebsiella species or Escherichia coli) as the previous room occupant.


Among 9, 371 eligible admissions (7, 651 unique patients), 267 (3%) involved patients who acquired an ESBL-producing pathogen in the ICU; of these patients, 32 (12%) were hospitalized in a room in which the prior occupant had been positive for ESBL. Logistic regression results suggested that the prior occupant's ESBL status was not significantly associated with acquisition of an ESBL-producing pathogen (adjusted odds ratio, 1.39 [95% confidence interval, 0.94-2.08]) after adjusting for colonization pressure and antibiotic exposure in the ICU. PFGE results suggested that 6 (18%) of 32 patients acquired a bacterial strain that was the same as or closely related to the strain obtained from the prior occupant.


These data suggest that environmental contamination may not play a substantial role in the transmission of ESBL-producing pathogens among ICU patients. Intensifying environmental decontamination may be less effective than other interventions in preventing transmission of ESBL-producing pathogens.

Original Article
Copyright © The Society for Healthcare Epidemiology of America 2013

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1.Paterson, DL, Bonomo, RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657686.CrossRefGoogle ScholarPubMed
2.Ramphal, R, Ambrose, PG. Extended-spectrum β-lactamases and clinical outcomes: current data. Clin Infect Dis 2006;42:164172.CrossRefGoogle ScholarPubMed
3.Ho, J, Tambyah, PA, Paterson, DL. Multiresistant gram-negative infections: a global perspective. Curr Opin Infect Dis 2010;23:546553.CrossRefGoogle ScholarPubMed
4.Flaherty, JP, Weinstein, RA. Nosocomial infection caused by antibiotic-resistant organisms in the intensive-care unit. Infect Control Hosp Epidemiol 1996;17:236248.CrossRefGoogle ScholarPubMed
5.Shaughnessy, MK, Micielli, RL, DePestel, DD, et al.Evaluation of hospital room assignment and acquisition of Clostridium difficile infection. Infect Control Hosp Epidemiol 2011;32:201206.CrossRefGoogle ScholarPubMed
6.Nseir, S, Blazejewski, C, Lubret, R, Wallet, F, Courcol, R, Durocher, A. Risk of acquiring multidrug-resistant gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2010;17:12011208.CrossRefGoogle ScholarPubMed
7.Drees, M, Snydman, DR, Schmid, CH, et al.Antibiotic exposure and room contamination among patients colonized with van-comycin-resistant enterococci. Infect Control Hosp Epidemiol 2008;29:709715.CrossRefGoogle ScholarPubMed
8.Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:19451951.CrossRefGoogle ScholarPubMed
9.Kac, G, Podglajen, I, Vaupre, S, Colardelle, N, Buu-Hof, A, Gutmann, L. Molecular epidemiology of extended-spectrum β-lactamase-producing Enterobacteriaceae isolated from environmental and clinical specimens in a cardiac surgery intensive care unit. Infect Control Hosp Epidemiol 2004;25:852855.CrossRefGoogle Scholar
10.Hobson, RP, MacKenzie, FM, Gould, IM. An outbreak of multiply-resistant Klebsiella pneumoniae in the Grampian region of Scotland. J Hosp Infect 1996;33:249262.CrossRefGoogle Scholar
11.Harris, AD, Kotetishvili, M, Shurland, S, et al.How important is patient-to-patient transmission in extended-spectrum β-lactamase Escherichia coli acquisition. Am J Infect Control 2007;35:97101.CrossRefGoogle ScholarPubMed
12.Harris, AD, Perencevich, EN, Johnson, JK, et al.Patient-to-patient transmission is important in extended-spectrum β-lactamase-producing Klebsiella pneumoniae acquisition. Clin Infect Dis 2007;45:13471350.CrossRefGoogle ScholarPubMed
13.Lautenbach, E, Harris, AD, Perencevich, EN, Nachamkin, I, Tolomeo, P, Metlay, JP. Test characteristics of peri-rectal and rectal swab compared to stool sample for detection of fluoroquino-lone-resistant Escherichia coli in the gastrointestinal tract. Antimicrob Agents Chemother 2005;49:798800.CrossRefGoogle Scholar
14.Sehulster, L, Chinn, RY; Centers for Disease Control and Prevention (CDC), Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for environmental infection control in health-care facilities: recommendations of the CDC and HICPAC. MMWR Recomm Rep 2003;52:142.Google ScholarPubMed
15.McGregor, JC, Kim, PW, Perencevich, EN, et al.Utility of the chronic disease score and Charlson comorbidity index as comorbidity measures for use in epidemiologic studies of antibiotic-resistant organisms. Am J Epidemiol 2005;161:483493.CrossRefGoogle ScholarPubMed
16.Furuno, JP, Harris, AD, Wright, MO, et al.Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission. Am J Infect Control 2004;32:436440.CrossRefGoogle ScholarPubMed
17.Furuno, JP, McGregor, JC, Harris, AD, et al.Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term care facility. Arch Intern Med 2006;166(5):580585.CrossRefGoogle Scholar
18.Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613619.CrossRefGoogle ScholarPubMed
19.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:11271132.CrossRefGoogle ScholarPubMed
20.Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing: 19th informational supplement. Clinical and Laboratory Standards Institute, 2009.Google Scholar
21.Johnson, JK, Smith, G, Lee, MS, et al.The role of patient-to-patient transmission in the acquisition of imipenem-resistant Pseudomonas aeruginosa colonization in the intensive care unit. J Infect Dis 2009;200:900905.CrossRefGoogle ScholarPubMed
22.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.Google ScholarPubMed
23.Williams, RL. A note on robust variance estimation for cluster-correlated data. Biometrics 2000;56:645646.CrossRefGoogle ScholarPubMed
24.D'Agata, E, Venkataraman, L, DeGirolami, P, Weigel, L, Samore, M, Tenover, F. The molecular and clinical epidemiology of Enterobacteriaceae-producing extended-spectrum β-lactamase in a tertiary care hospital. J Infect 1998;36:279285.CrossRefGoogle Scholar
25.Harris, AD, McGregor, JC, Johnson, JA, et al.Risk factors for colonization with extended-spectrum β-lactamase-producing bacteria and intensive care unit admission. Emerg Infect Dis 2007;13:11441149.CrossRefGoogle ScholarPubMed
26.Ben-Ami, R, Schwaber, MJ, Navon-Venezia, S, et al.Influx of extended-spectrum β-lactamase-producing Enterobacteriaceae into the hospital. Clin Infect Dis 2006;42:925934.CrossRefGoogle ScholarPubMed
27.Pessoa-Silva, CL, Meurer Moreira, B, Camara Almeida, V, et al.Extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit: risk factors for infection and colonization. J Hosp Infect 2003;53:198206.CrossRefGoogle Scholar
28.Bisson, G, Fishman, NO, Patel, JB, Edelstein, PH, Lautenbach, E. Extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species: risk factors for colonization and impact of antimicrobial formulary interventions on colonization prevalence. Infect Control Hosp Epidemiol 2002;23:254260.CrossRefGoogle ScholarPubMed
29.Ariffin, H, Navaratnam, P, Mohamed, M, et al.Ceftazidime-resistant Klebsiella pneumoniae bloodstream infection in children with febrile neutropenia. Int J Infect Dis 2000;4:2125.CrossRefGoogle ScholarPubMed
30.Wiener, J, Quinn, JP, Bradford, PA, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517523.CrossRefGoogle ScholarPubMed
31.Soulier, A, Barbut, F, Ollivier, JM, Petit, JC, Lienhart, A. Decreased transmission of enterobacteriaceae with extended-spectrum β-lactamases in an intensive care unit by nursing reorganization. J Hosp Infect 1995;31:8997.CrossRefGoogle Scholar
32.Ajao, AO, Harris, AD, Roghmann, MC, et al.Systematic review of measurement and adjustment for colonization pressure in studies of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and Clostridium difficile acquisition. Infect Control Hosp Epidemiol 2011;32:481489.CrossRefGoogle ScholarPubMed