Screening for Intestinal Carriage of Extended-spectrum Beta-lactamase–producing Enterobacteriaceae in Critically Ill Patients: Expected Benefits and Evidence-based Controversies

• Published in: Clinical infectious diseases 2019-05, Vol.68 (12), p.2125-2130
• Main Authors: Zahar, Jean-Ralph, Blot, Stijn, Nordmann, Patrice, Martischang, Romain, Timsit, Jean-François, Harbarth, Stephan, Barbier, François
• Format: Article
• Language: English
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/ciy864

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 in controlling the spread of ESBL-E in ICUs with high compliance to standard hygiene precautions and no ongoing outbreak of ESBL-producing Klebsiella pneumoniae or Enterobacter spp. Besides, given their debated performance to positively predict which patients are 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. Extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E) carriers have limited value for preventing cross-transmission events in those intensive care units (ICUs) applying current hygiene standards. Novel diagnostic approaches for ICU-acquired ESBL-E infections should replace the patient colonization status for empirical carbapenem use.