Carriers of the highly resistant ESBL-producing Enterobacteriaceae (ESBL-E) can be nursed in a hospital together with wardmates in a multiple-bed room if contact precautions are taken without without additional risk of infection. Dutch research, coordinated from Amphia Hospital and UMC Utrecht, has shown that the risk of infection by nursing in a multiple-bed room is not higher as compared to a single-bed room.

To prevent the spread of highly resistant bacteria such as the ESBL-producing Enterobacteriaceae (ESBL stands for 'extended-spectrum beta-lactamase') in hospitals, infection prevention guidelines now recommend that contact precautions be applied to patients that are carrier of this bacterium, preferably with nursing in a single-bed room. However, the availability of single-bed rooms is limited in many hospitals. In addition, studies are ambiguous on the added value of single-bed rooms in controlling the spread of resistant bacteria.

Comparable risk of spreading the ESBL bacteria
In a large, well-controlled study conducted in 16 Dutch hospitals and published in Lancet Infectious Diseases, carriers of ESBL-E were compared regarding the risk of infecting wardmates by nursing in either a single-bed or a multiple-bed room. The analysis showed that the risk of infection of wardmates by ESBL-E carriers was comparable between the two groups: 4% (11 out of 275 patients) in a single-bed room and 7% (14 out of 188 patients) in a multiple-bed room (difference 3.4%; 90% CI -0.3 to 7.1). There was also no relationship between room type and the length of hospital stay or hospital mortality.

No added value single room
Researcher Dr. Marjolein Kluytmans-van den Bergh (Amphia, Breda and UMC Utrecht), specialized in the epidemiology of infectious diseases, concludes: “Our study is the first to show the added value of nursing ESBL-E carriers in a single-bed room in a hospital setting. The results show that, when taking contact precautions, nursing in a single-bed room has no added value over a multiple-bed room. We therefore propose reconsidering the recommendation to nurse such patients in single-bed rooms. This allows doctors to act more flexible in daily practice and to provide more efficient hospital care, without additional risk for the patient.”

Healthcare-related infections
Healthcare-related infections are a major cause of disease and death worldwide and are increasingly caused by resistant bacteria. Careful use of antibiotics and adequate infection control measures to prevent the spread of antibiotic resistance in hospitals are therefore of great importance. ESBL-E produce an enzyme (beta-lactamase) that breaks down antibiotics more rapidly, so that they no longer work, resulting in development of resistance. Doctors estimate that in Europe between 4 and 12 percent of patients are ESBL-E carriers upon hospital admission.

Reference
Kluytmans-van den Bergh MFQ, Bruijning-Verhagen PCJ, Vandenbroucke-Grauls CMJE, de Brauwer EIGB, Buiting AGM, Diederen BM, et al. Contact precautions in single-bed rooms for patients with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Dutch hospitals: a cluster-randomized, crossover, non-inferiority study. Lancet Infectious Diseases 2019, https://doi.org/10.1016/S1473-3099(19)30262-2