Background: The efficacy of interventions to prevent in-hospital transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is poorly defined, particularly for admission screening. Methods: Variability in ESBL-E infection control practices was evaluated with a survey of 15 hospitals. All ESBL-E positive clinical and screening specimens at 12 hospitals (6 screening and 6 non-screening) from 2005-2009 were included and defined as hospital-onset or community-onset using standard definitions. ESBL-E incidence and susceptibility were studied. Screening efficacy was evaluated with a negative binomial model, adjusting for study year and incidence of community-onset cases. Results: Diverse practices in infection control for ESBL-E were found with 53.3% of hospitals utilizing admission screening. Overall incidence and hospital-onset cases increased 4-fold and 2-fold, respectively. Fluoroquinolone susceptibility for E. coli (12.8%) and K. pneumoniae (9.0%) was low. Hospital-onset cases were 49.1% lower in screening compared to non-screening hospitals (p<0.001). Conclusion: Admission screening can reduce the incidence of hospital-onset ESBL-E cases.

Background: The efficacy of interventions to prevent in-hospital transmission of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) is poorly defined, particularly for admission screening. Methods: Variability in ESBL-E infection control practices was evaluated with a survey of 15 hospitals. All ESBL-E positive clinical and screening specimens at 12 hospitals (6 screening and 6 non-screening) from 2005-2009 were included and defined as hospital-onset or community-onset using standard definitions. ESBL-E incidence and susceptibility were studied. Screening efficacy was evaluated with a negative binomial model, adjusting for study year and incidence of community-onset cases. Results: Diverse practices in infection control for ESBL-E were found with 53.3% of hospitals utilizing admission screening. Overall incidence and hospital-onset cases increased 4-fold and 2-fold, respectively. Fluoroquinolone susceptibility for E. coli (12.8%) and K. pneumoniae (9.0%) was low. Hospital-onset cases were 49.1% lower in screening compared to non-screening hospitals (p<0.001). Conclusion: Admission screening can reduce the incidence of hospital-onset ESBL-E cases.