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Extended-Spectrum Beta-lactamase (ESBL) – Producing Bacteria

Extended-spectrum beta-lactamases are chemicals made by certain kinds of germs (bacteria). These germs (or ESBL for short) break down several types of antibiotics (medications that fight infection). So, when a person gets sick because of ESBL, the infection is harder to treat with those antibiotics. ESBL is mainly spread among people in hospitals and long-term care facilities. Infections due to ESBL usually affect the urinary tract and gut (intestine). They can also affect wounds and the blood. Sometimes a person can carry ESBL and not be sick. This is called being colonized with ESBL. This person can spread ESBL to others. But because the person is not sick, no treatment is needed. ESBL infections, on the other hand, 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.

What Are the Risk Factors 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 and include:

  • A current or recent stay in a hospital or long-term facility

  • A current or recent stay in the intensive care unit (ICU) or neonatal intensive care unit (NICU)

  • A recent operation or wound treatment

  • Having a urinary catheter, feeding tube, or other tube placed in the body

  • Older age

  • Being a premature baby

  • Having a weakened immune system, such as after an organ transplant

  • Having long-term or frequent antibiotic treatment

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 patient, 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.

What Are the Symptoms of ESBL Infection?

ESBL causes different symptoms depending on the location of the infection. Common locations 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 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?

A sample of urine, stool, infected tissue, or blood, is taken to diagnose an ESBL infection.  A swab of the area around the rectum or of another location of the body may also be taken. The sample and/or swab is then sent to a laboratory and tested for ESBL.

How Is ESBL Colonization Treated?

A person who tests positive for ESBL colonization usually is not treated. This is because there is no effective treatment and further antibiotic resistance could result from treatment. In some cases, the body can get rid of the germs on its own, even after having been colonized for many months.

How Is ESBL Infection Treated?

Because ESBL germs are resistant to many kinds of antibiotics, your doctor will tell you how you’ll be treated. Most likely a combination of several antibiotics will be tried.

Preventing ESBL: What Hospitals Are Doing

Many hospitals and long-term care facilities take steps to help prevent ESBL:

Healthcare provider washing hands with soap at hospital room sink. Man in hospital bed reflected in mirror over sink.

  • 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 patient. 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 patient with ESBL. Before leaving the room, they remove these items and clean their hands.

  • Private rooms:  Patients with ESBL are placed in private rooms or in a room with another patient who also has ESBL.

  • Personal care items:  Patients 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 facilities monitor the presence and spread of ESBL and educate caregivers on the best ways to prevent it.

Preventing ESBL: What Patients Can Do

  • Ask all hospital staff to wash their hands before touching you. Don’t be afraid to speak up!

  • Wash your own hands frequently with soap and warm water. Or use an alcohol-based hand gel containing at least 60 percent 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 will also likely be instructed 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 patient rooms.

  • If you need to have a test done, such as an x-ray, follow instructions from staff. You’ll likely 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 containing at least 60 percent 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 patient. An alcohol-based hand gel containing at least 60 percent alcohol can be used instead 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 patient’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, develop when antibiotics are taken longer than necessary or are taken when they’re not needed. 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.