Abstract
BackgroundAntimicrobial resistance poses a risk for healthcare, both in the community and hospitals. The spread of multidrug-resistant organisms (MDROs) occurs mostly on a local and regional level, following movement of patients, but also occurs across national borders.AimThe aim of this observational study was to determine the prevalence of MDROs in a European cross-border region to understand differences and improve infection prevention based on real-time routine data and workflows.MethodsBetween September 2017 and June 2018, 23 hospitals in the Dutch (NL)–German (DE) cross-border region (BR) participated in the study. During 8 consecutive weeks, patients were screened upon admission to intensive care units (ICUs) for nasal carriage of meticillin-resistant Staphylococcus aureus (MRSA) and rectal carriage of vancomycin-resistant Enterococcus faecium/E. faecalis (VRE), third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE) and carbapenem-resistant Enterobacteriaceae (CRE). All samples were processed in the associated laboratories.ResultsA total of 3,365 patients were screened (median age: 68 years (IQR: 57–77); male/female ratio: 59.7/40.3; NL-BR: n = 1,202; DE-BR: n = 2,163). Median screening compliance was 60.4% (NL-BR: 56.9%; DE-BR: 62.9%). MDRO prevalence was higher in DE-BR than in NL-BR, namely 1.7% vs 0.6% for MRSA (p = 0.006), 2.7% vs 0.1% for VRE (p < 0.001) and 6.6% vs 3.6% for 3GCRE (p < 0.001), whereas CRE prevalence was comparable (0.2% in DE-BR vs 0.0% in NL-BR ICUs).ConclusionsThis first prospective multicentre screening study in a European cross-border region shows high heterogenicity in MDRO carriage prevalence in NL-BR and DE-BR ICUs. This indicates that the prevalence is probably influenced by the different healthcare structures.
Highlights
Antimicrobial resistance (AMR) is a growing public health threat worldwide
To the best of our knowledge, this is the first prospective observational multicentre screening study focussing on intensive care units (ICUs) admission prevalence of the most common multidrug-resistant organisms (MDROs) in a healthcare region that comprises a national border
This study has been performed by a team within the Dutch–Gram-negative MDROs into 3MRGN and 4MRGN (German) cross-border network, which has a long-lasting experience in close cooperation in the domain of AMR and infection prevention and control [23,24]
Summary
Antimicrobial resistance (AMR) is a growing public health threat worldwide. multidrugresistant organisms (MDRO) pose major health risks to humans both in the community and within healthcare facilities [1,2]. Patients colonised and/or infected with MDROs have prolonged hospital stays, higher risks for complications, and an increased morbidity and mortality, all of which increase healthcare costs [3,4]. To decrease these risks, the World Health Organization (WHO) has urgently advised changing the way antibiotics are prescribed. There are still information gaps, especially with respect to twelve MDROs, which have been categorised as urgently requiring new antibiotics and improved combat strategies [6,7] These MDROs include among others: meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), extended spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and carbapenemresistant Enterobacteriaceae (CRE) [7]. This indicates that the prevalence is probably influenced by the different healthcare structures
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