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However, compliance with these precautions needs to be high in order to ensure the effectiveness of these precautions. Furthermore, we recommend that, in outbreak situations, patients who have gastrointestinal tract colonization as well as those with frank infection should undergo contact isolation (table 2). Gastrointestinal tract colonization can be detected by using media supplemented with cefotaxime or other third-generation cephalosporins. Standard methods of hand hygiene, screening for colonization and patient isolation may not always be effective in controlling outbreaks of ESBL-producing organisms [58].

2005. Available at www. pdf (accessed August 22, 2005). 138 Dellit T, Duchin J, Hofmann J, Gurmai Olson E: Interim Guidelines for Evaluation and Management of Community Associated Methicillin Resistant Staphylococcus aureus Skin and Soft Tissue Infections in Outpatient Settings. 2004. pdf (accessed June 27, 2005). 139 Wenzel RP, Reagan DR, Bertino JS Jr, Baron EJ, Arias K: Methicillin-resistant Staphylococcus aureus outbreak: a consensus panel’s definition and management guidelines. Am J Infect Control 1998;26: 102–110.

Other case-control studies have not shown an association [10, 21, 23]. A tight correlation has existed between ceftazidime use in individual wards within a hospital and prevalence of ceftazidime-resistant strains in those wards [41]. In a survey of 15 different hospitals, an association existed between cephalosporin and aztreonam usage at each hospital and the isolation rate of ESBL-producing organisms at each hospital [42, 43]. Use of a variety of other antibiotic classes has been found to be associated with subsequent infections due to ESBL-producing organisms.

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