The Causes and Control Measures of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae in Long-Term Care Facilities: A Systematic Review and Meta-Analysis

Ismaila Olatunji Sule; Aaron Mendelsohn; Raymond M Panas

doi:10.1177/23333928221131709

The Causes and Control Measures of Extended Spectrum Beta-Lactamase Producing Enterobacteriaceae in Long-Term Care Facilities: A Systematic Review and Meta-Analysis

Health Serv Res Manag Epidemiol. 2022 Oct 17:9:23333928221131709. doi: 10.1177/23333928221131709. eCollection 2022 Jan-Dec.

Authors

Ismaila Olatunji Sule^{1

2}, Aaron Mendelsohn³, Raymond M Panas³

Affiliations

¹ Microbiology Department, NHS Western Isles, Stornoway, Isle of Lewis, Scotland.
² Microbiology Department, Biomedical Science Consulting Service, IG4M, Belfast, United Kingdom.
³ Senior Contributing Faculty, Public Health Department, College of Health Professions, Walden University, Minneapolis, USA.

Abstract

Background: Due to extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE), infections among residents are increasing in long-term care facilities (LTCFs), resulting in a high rate of morbidity and healthcare costs. A designated infection control team is unavailable to control the disease.

Methods: A systematic review and meta-analysis were conducted to characterize the causes of ESBL-PE and evaluate the infection control strategies within LTCFs. Multiple regression analysis (MRA) was included as supplementary statistical analysis to identify relationships between LTCFs, geographical locations, infection control measures (ICMs), and ESBL-PE. A systematic search was conducted for studies from January 2008 to December 2018. Twenty-two of the 3106 studies met the inclusion criteria.

Results: The pooled prevalence for ESBL-PE among LTCFs residents was a mean difference (MD) of 15.78 (95% CI: 0.04, 31.53). Risk factors included the influence of regional areas was a standardized mean difference (SMD) of 0.61(95% CI: 0.32, 0.91) in Europe, SMD was 14.92 (95% CI: 9.17, 20.68) in Asia, and SMD was 0.51(95% CI: 0.35, 0.67) in other regions (North America and Australia). Nine of 22 studies reported ICMs were MD of 13.59 (95% CI: 5.32, 21.86).

Conclusions: Meta-analysis and MRA revealed a statistically significant association between LTCF and ESBL-PE among residents (p = .05). Strict adherence to infection control measures in LTCFs is needed to address this ESBL-PE prevalence among residents. The potential positive social change is promoting knowledge about vulnerable residents in LTCFs and the community factors responsible for ESBL infection.

Keywords: disease management; extended-spectrum beta-lactamase-producing enterobacteriaceae (ESBL-PE); infection control measures (ICMs); long-term care facilities (LTCFs); prevention; residents.

Publication types

Review