Wide dissemination of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella spp. in acute care and rehabilitation hospitals.

A prospective surveillance system for extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E) and ESBL-producing Klebsiella spp. (ESBL-K) was implemented in 39 German hospitals with the aim of determining the incidence densities (IDs) of community-onset and hospital-onset cases and of identifying risk factors for high IDs of hospital-onset cases. During 2008, 2081 ESBL-E/K cases were documented. ESBL-E cases (n=1330, 63·9%) were more common than ESBL-K cases (n=751, 36·1%), but a higher proportion of ESBL-K cases (59%) than of ESBL-E cases (39·5%) were hospital-onset cases. The mean IDs were 0·54 (range 0-2·53) per 1000 patient-days for all ESBL-EK cases, 0·29 (range 0-1·81) per 1000 patient-days for community-onset ESBL-EK cases and 0·25 (range 0-1·82) per 1000 patient-days for hospital-onset ESBL-EK cases. Regression analysis showed a linear association between the IDs of community-onset and hospital-onset cases. The wide dissemination of ESBL-E and ESBL-K emphasizes the need for hospital-wide surveillance to guide control measures.