6/29/23, 11:57 PM SoM Pathway Feedback Search Clinical Topics Home Studies SoM SoM Disease Antimicrobial-resistant Gram-ne Trial question Is the isolation strategy of contact precautions in a multiple-bed room noninferior to a strategy of contact precautions in a single-bed room for patients with extended-spectrum -lactamase- producing Enterobacteriaceae? Study design Multi-center Open label RCT Population Characteristics of study participants 45.4% female N = 10220 54.6% male 10220 patients (4532 female, 5452 male) Inclusion criteria: adult patients with extended-spectrum -lactamase-producing Enterobacteriaceae cultured from a routine clinical sample Key exclusion criteria: age < 18 years, a strict indication for barrier precautions in a single-bed room, no culture result reported within 7 days after the culture was obtained or before discharge, a wardmate known to be colonized or infected with an ESBL-producing Enterobacteriaceae isolate of the same bacterial species with a similar antibiogram Interventions https://web.pathway.md/studies/recEZwZylaRgLSO5q 1/2 6/29/23, 11:57 PM SoM Pathway N=304 + 4578 a multiple-bed room isolation strategy (contact precautions in a multiple-bed room consisting of index patients plus wardmates) N=312 + 4790 a single-bed room isolation strategy (contact precautions in a single-bed room with index patients plus wardmates) Primary outcome Transmission of extended-spectrum -lactamase-producing Enterobacteriaceae to at least one wardmate 7.0 % 7 5.3 % 4 3.5 % Difference not exceeding nonferiority margin 1.8 % 0.0 % A multiple-bed room isolation strategy A single-bed room isolation strategy Difference not exceeding nonferiority margin in transmission of extended-spectrum -lactamase- producing Enterobacteriaceae to at least one wardmate (7% vs. 4%; ARD 3.4, 90% CI -0.3 to 7.1) Secondary outcomes No significant difference in rectal carriage of ESBL-producing Enterobacteriaceae in all wardmates (9% vs. 8%; RR 1.14, 95% CI 0.97 to 1.33) No significant difference in length of hospital stay in wardmates (11 days vs. 11 days; RR 1.02, 95% CI 0.96 to 1.08) No significant difference in death at 30 days in wardmates (4% vs. 4%; RR 1.14, 95% CI 0.9 to 1.43) Conclusion In adult patients with extended-spectrum -lactamase-producing Enterobacteriaceae cultured from a routine clinical sample, a multiple-bed room isolation strategy was noninferior to a single-bed room isolation strategy with respect to transmission of extended-spectrum -lactamase-producing Enterobacteriaceae to at least one wardmate. Reference Marjolein F Q Kluytmans-van den Bergh, Patricia C J Bruijning-Verhagen, Christina M J E Vandenbroucke-Grauls et al. Contact precautions in single-bed or multiple-bed rooms for patients with extended-spectrum -lactamase-producing Enterobacteriaceae in Dutch hospitals: a cluster- randomised, crossover, non-inferiority study. Lancet Infect Dis. 2019 Oct;19(10):1069-1079. Open reference URL https://web.pathway.md/studies/recEZwZylaRgLSO5q 2/2