Extended-Spectrum Beta-Lactamase-Producing Bacteria
Extended-spectrum beta-lactamases are enzymes made by certain kinds of germs (bacteria). These germs (or ESBL for short) break down several types of antibiotic medicine. So when you get sick because of ESBL, the infection is harder to treat and you may need different antibiotics. Infections caused by ESBL usually affect the urinary tract and gut (intestine). They can also infect wounds and the blood. ESBL is mainly spread among people in hospitals and long-term care facilities. Sometimes you can carry ESBL and not be sick. This is called being colonized with ESBL. You can spread ESBL to others. But because you aren't sick, you don't need treatment. But if ESBL enters the body and causes an infection, this can be fatal if not treated properly. This sheet tells you more about ESBL and what hospitals are doing to control this serious problem. It also tells you how you can help in this effort.
Who is at risk for ESBL Infection?
Healthy people usually are not colonized or infected with ESBL. But certain things can make colonization or infection more likely. These are called risk factors. They include:
A current or recent stay in a hospital or long-term care facility
A current or recent stay in the intensive care unit (ICU) or neonatal intensive care unit (NICU)
A recent surgery or wound treatment
Having a urinary catheter, feeding tube, or other tube placed in the body
Having a weakened immune system, such as after an organ transplant
Having long-term antibiotic treatment or having it often
Close and prolonged contact with a person who is colonized or sick from an ESBL, such as caring for a friend or relative who has returned home from a hospital
How does ESBL spread?
Ways that ESBL can spread include:
Someone who is colonized or infected with ESBL touches you with unwashed hands.
You touch objects or surfaces that have the germs.
Healthcare workers touch you without washing their hands properly after contact with an infected person, object, or surface.
ESBL can enter your body in the following ways:
Through the mouth. This happens if you have the germs on your hands and then touch your mouth, such as when you eat. The germs are then swallowed and live in your intestine.
Through the urinary tract. This occurs if you already have ESBL in your bowel and do not cleanse properly after a bowel movement. ESBL can also enter the urinary tract through a urinary catheter, if you have one.
Through a wound.
Through the airway. This happens if the person with the ESBL coughs or sneezes on you.
What are the symptoms of ESBL infection?
ESBL causes different symptoms, depending on where the infection is. Common places and symptoms include:
Urinary tract: pain and burning when urinating, the need to urinate more often, fever
Intestine: diarrhea (may be bloody), pain in the belly (abdomen), stomach cramps, gas, fever, loss of appetite
Skin wound: redness of the skin around the wound and oozing of fluid from the wound
Blood: high fever, chills, nausea and vomiting, shortness of breath, confusion
How is ESBL infection diagnosed?
Your healthcare provider will take a sample of urine, stool, infected tissue, or blood. He or she may also take a swab of the area around the rectum or of another place in the body. The sample, swab, or both are sent to a lab and tested for ESBL. The results usually take 2 to 5 days. But newer techniques may make this information available in a few hours.
How is ESBL colonization treated?
If you test positive for ESBL colonization, you usually will not get treated. This is because no treatment is necessary. Any treatment could cause more antibiotic resistance. In some cases, your body can get rid of the germs on its own. This can be true even after having been colonized for many months.
How is ESBL infection treated?
Because ESBL germs are resistant to many kinds of antibiotics, your healthcare provider will tell you how you’ll be treated. You may be given a combination of several antibiotics.
Preventing ESBL: What hospitals are doing
Many hospitals and long-term care facilities take steps to help prevent ESBL:
Handwashing. This is the single most important way to help prevent the spread of germs. Healthcare workers wash their hands with soap and water or use an alcohol-based hand cleanser before and after treating each person. They also clean their hands after touching any surface that may be contaminated with germs.
Protective clothing. Healthcare workers and visitors will likely wear gloves and a gown when entering the room of a person with ESBL. Before leaving the room, they remove these items and clean their hands.
Private rooms. People with ESBL are put in private rooms.
Personal care items. People with ESBL may have their own patient care items, such as thermometers and stethoscopes. If these items are shared, they are fully cleaned and disinfected before reuse.
Monitoring. Hospitals and long-term care facilities monitor the presence and spread of ESBL. They teach caregivers the best ways to prevent it.
Preventing ESBL: What you as a patient can do
Ask all hospital staff to wash their hands before touching you. Don’t be afraid to speak up!
Wash your own hands often with soap and warm water. Or use an alcohol-based hand gel that is at least 60% alcohol.
Ask that stethoscopes and other instruments be cleaned with alcohol before they are used on you.
Ask visitors to wash their hands before they enter and right after they leave your room. Visitors also may be told by hospital staff to put on protective gloves and a hospital gown when they’re in your room. Just before leaving your room, they will take these off.
Stay in your room. Do not go into the hallway or other places, such as the visitor waiting area, ward kitchen, hospital cafeteria, or other people's rooms.
If you need to have a test done, such as an X-ray, follow instructions from staff. You may need to change into a clean hospital gown and wash your hands just before leaving your room.
Preventing ESBL: What you can do after leaving the healthcare facility
Wash your hands often with soap and warm water. Or use an alcohol-based hand gel that is at least 60% alcohol. Hand cleaning is especially important after going to the bathroom and before preparing and eating food.
Follow instructions that you’ve been given for caring for surgical wounds or any tubes that you have, such as a catheter or dialysis port.
Keep cuts and scrapes clean and covered until they heal.
Do not share towels, razors, clothing, or athletic equipment.
Tell your other healthcare providers that you have ESBL, so that they can take precautions to prevent its spread.
Tips for good handwashing
Use warm water and plenty of soap. Work up a good lather.
Clean the whole hand, under your nails, between your fingers, and up the wrists.
Wash for at least 15 seconds. Don’t just wipe. Scrub well.
Rinse, letting the water run down your fingers, not up your wrists.
Dry your hands well. In a public restroom, use a paper towel to turn off the faucet and open the door.
Using alcohol-based hand gels
Alcohol-based hand gels can be used when your hands aren’t visibly dirty.
Use enough gel to get your hands completely wet.
Rub your hands together briskly, cleaning the backs of your hands, the palms, between your fingers and up the wrists.
Rub until the gel is gone and your hands are completely dry.
Precautions when caring for someone with ESBL
Wash your hands well with soap and warm water before and after any contact with the person. Use an alcohol-based hand gel that is least 60% alcohol if your hands aren’t visibly dirty.
Wear disposable gloves when changing a bandage or touching an infected wound. Throw away the gloves after each use. Then wash your hands well.
Wash and dry the person’s bed linen, towels, and clothing using the warmest temperatures recommended on the labels. Use liquid bleach during the wash cycle if the label permits.
Understanding drug resistance
Hard-to-kill (resistant) germs, such as ESBL, often develop when antibiotics are taken. They can also develop when antibiotics are taken when they aren't needed, or are not taken exactly as directed. This might mean not taking the full prescribed course. This is because any germs that survive treatment with an antibiotic can go on to reproduce and create more resistant germs. The more often antibiotics are used, the more chances resistant germs have to develop. This is why your healthcare provider may hesitate to prescribe antibiotics unless he or she is certain that they are needed.
October 08, 2017
Extended-spectrum beta-lactamases. UpToDate.
Lentnek, Arnold, MD,Sather, Rita, RN