Impact of single room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli

Background: Colonisation and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is discussed controversially, as evidence is limited. Methods: We performed a prospective, multicentre cohort-study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonisation or bloodstream infection (BSI) with F3GCR-EC and 3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates characterised with molecular typing methods including whole genome sequencing and core genome MLST to assess potential patient-to-patient transmission. Potential confounders were assessed by multivariate logistic regression analysis. Findings: Within 12 months, 1,386 patients at NCP and 1,586 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 1·59% and 1·01% of patients, respectively (p=0·191). There were three BSI by F3GCR-EC in NCP and four in SCP sites (p=1·000). Patient-to-patient transmissions occurred in three cases at NCP and SCP sites each (p=1·000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3,664. Interpretation: SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting. Based on our comprehensive data analysis, this should also be valid for all 3GCR-EC.