Extended-Spectrum Beta-Lactamase (ESBL)-Producing Bacteria

Extended-spectrum-beta-lactamase (ESBL)-producing bacteria are a group of bacteria that produce enzymes (beta-lactamases) that can break down many common antibiotics, making antibiotics ineffective. The significance of ESBL production in bacteria is that antibiotic treatment options may be limited for certain infections.

Information Sheet for Patients and Visitors

See page 58-59 of Annex A: Screening, Testing and Surveillance for Antibiotic-Resistant Organisms (AROs) in All Health Care Settings for an information Sheet for Patients and Visitors

How it Spreads

  • Directly through touch if hands are unwashed after exposure to the bacteria. It spreads primarily via unwashed hands of healthcare providers.
  • Indirectly by contact with soiled equipment, especially urine-care equipment such as catheters or urinals.
  • Indirectly by contact with contaminated environmental surfaces, such as counters, sinks, or doorknobs.

ESBL Colonization and Infection

  • Colonization: for most people ESBL does not cause harm and does not cause any symptoms. These people are called carriers and are considered colonized.
  • Infection: for the few people who develop an infection, the symptoms are specific to what part of the body is infected. This can include symptoms of urinary tract, wound, pneumonia, or blood infections.
  • A rectal swab or stool sample can determine if you are colonized or infected with ESBL. If indicated, a urine specimen can also be collected.

Risk Factors for Infection and Colonization

  • Prolonged and extensive treatments with certain antibiotics.
  • Prolonged hospital or intensive care unit (ICU) stay.
  • Severe illness, especially neutropenia, organ transplants, those requiring total parenteral nutrition, and neonates.
  • Organ transplants.
  • Presence of indwelling catheters, especially urinary and arterial/central venous catheters.
  • Mechanical ventilation.
  • Renal replacement therapy.
  • Household contact of a patient with ESBL.
  • Those previously colonized or infected with ESBL.
  • Those exposed to a facility with an ESBL outbreak.

Prevention

  • Wash your hands thoroughly and often with warm soapy water for at least 15 seconds, especially:
    • after going to the washroom.
    • after blowing your nose.
    • before eating and drinking or preparing food.
    • before and after caring for someone who is sick.
    • before and after touching any dressings or wounds.
    • if you are a staff or visitor and have contact with a patient or resident in a healthcare facility.
  • If you are a resident or patient in a healthcare facility:
    • Ensure those providing care to you or visiting are washing their hands prior to contact with you.
    • Do not take antibiotics unless it is required and ensure you take them exactly the way they were prescribed.
    • Ensure routine cleaning and disinfection of common touch surfaces including faucets, door handles, bedrails, bathrooms, and other surfaces that people touch is performed.

Treatment

  • Appropriate use of antibiotics is important to ensure effective treatments are available if the need should arise.
  • People who are carriers of ESBL do not require antibiotic treatment since this could lead to increased antibiotic resistance.
  • ESBL infections may require antibiotic treatment.

Individual cases are not reportable to the Health Unit.

No exclusion necessary unless too ill to participate in regular activities.

Follow the direction of your healthcare provider or occupational health at your workplace.

Note: Exclusion guidelines may differ for healthcare workers.

Infection Prevention and Control

Screening

Routine screening of individuals for ESBL-producing bacteria should be based on local epidemiology. See the PIDAC document Annex A: Screening, Testing and Surveillance for Antibiotic-resistant Organisms (AROs) for additional information.

Additional Precautions

Initiation of contact precautions for ESBL-producing bacteria may be indicated based on facility's ESBL program. See Provincial Infectious Diseases Advisory Committee (PIDAC) document Annex A: Screening, Testing and Surveillance for Antibiotic-resistant Organisms (AROs) for additional information.

Cleaning and Disinfection

Routine cleaning practices and routine discharge cleaning practices are adequate for the cleaning of rooms, and no special handling or precautions are required for linen. For clients/patients/residents on contact precautions, there must be a process in place to ensure that there has been adequate cleaning and disinfection of the space and shared equipment following discharge or transfer. See the PIDAC document Best Practices for Environmental Cleaning for Infection Prevention and Control, p. 107-108.

Laboratory Testing

Public Health Ontario Laboratory performs Extended Spectrum Beta-Lactamase (ESBL) confirmation testing on appropriate isolates, see Public Health Ontario: ESBL-Extended Spectrum Beta-Lactamase Confirmation for information.

More Resources

Staff working in a health care setting can review the Staff Fact Sheet (p.52) found in the PIDAC document.

Provincial Infectious Diseases Advisory Committee. February 2013. Annex to Routine Practices and Additional Precautions. Annex A: Screening, Testing and Surveillance for Antibiotic Resistant Organisms (AROs) in all Health Care Settings. Ontario Ministry of Health and Long-Term Care. Toronto: Canada.

Contact our Communicable Disease Control (CDC) program at 705-474-1400 or toll free at 1-800-563-2808, ext. 5229, or by email to cdc@healthunit.ca for more information.

Last updated: Nov. 2025, by CDC

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