table 1. Studies That Reported the Incidence of Extended-Spectrum β-Lactamase (ESBL) Infections


First Author, Study Period


Freeman et al17 2005–2008


Han et al18 2005–2009


Hidron et al19 2006–2007


Landman et al20 1999, 2001, 2006


Larson et al21 2001–2003


Lipworth et al22 1997–2002


Culture Types


Most from urine, blood, sputum


Urine


Blood, urine, respiratory


No specific cultures collected


Blood Urine Study Population ESBL Definition


16 community hospitals in North Carolina Used methods from the Clinical Laboratory Standards Institute or automated methods such as Vitek II (bioMerieux) or Microscan Walkaway (Dade Behring)


3 hospitals in the University of Pennsylvania Health System: academic tertiary-care medical center, urban community hospital, and acute-care urban hospital


National Healthcare Safety Network (nationwide)


15 hospitals in Brooklyn, NY


2 NICUs within New York Presbyterian Hospital System in New York City


2 tertiary-care medical center urban community hospitals (probably within University of Pennsylvania Health System)


Used methods from the Clinical Laboratory Standards Institute


Extended-spectrum cephalosporin resistant


Summary of Incidence


Cases per 10,000 patient days – E. coli range, 0–1.203 – KLEB range 0.837–1.011


E. coli and KLEB cases per 10,000 patient days


– Preintervention, 1.42 – Postintervention, 2.16


KLEB cases per 1,000 device days – CLABSI, 0.051 – CAUTI, 0.061 – VAP, 0.064


Ceftazidime or ceftriaxoneMIC >1mg/L KLEB cases per 10,000 discharges – 1999, 8.55 – 2001, 9.63 – 2006, 16.64


Automated methods such as Vitek II (bioMerieux) or Microscan Walkaway (Dade Behring) for resistance to cefotaxime Used NCCLS guideline


Cases per 100 admissions – E. coli,0 – K. pneumoniae, 0.51 – K. oxytoca,0


E. coli and KLEB cases per 10,000 patient days Hospital A: – Preintervention, 4.2 – Postintervention, 2.3 Hospital B: – Preintervention, 4.5 – Postintervention, 3.5


Soe et al23 2011


Stoll et al24 2002–2003


Swami et al25 2005–2009


Blood


Blood Urine


National Healthcare Safety Network (nationwide)


Very-low-birth-weight infants, 16 hospitals in the Neonatal Research Network


2 hospitals in Rochester Epidemiology Project Olmsted County


Intermediate or resistant to cefotaxime, ceftazidime, or cefepime by methods from the Clinical Laboratory Standards Institute


Resistant to ceftazidime and cefotaxime


Resistant to at least ceftriaxone, or cefotaxime, ceftazidime, or cefepime


KLEB per 1,000 central-line days per state (range, 0–0.37)


E. coli cases, 1 per 5,999 infants


E. coli cases per 100,000 person years (range, 5.82–21.53)


NOTE. KLEB, Klebsiella species; CLABSI, central line-associated bloodstream infections; CAUTI, catheter-associated urinary tract infection; VAP, ventilator-associated pneumonia.


esbl infections in the united states 1211


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