Abstract
Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1st 2014 and December 31st 2015 for methicillin resistant Staphylococcus aureus (MRSA) and for multidrug-resistant Enterobacteriaceae (MDRE). We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL) positive strains (RR: 2.4; 95% CI: 1.6–3.4) was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%). 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients.
Highlights
The Netherlands has a low prevalence of multidrug-resistant organisms (MDRO) compared to other countries in Europe
We reported a 31% carriage rate of multidrug-resistant microorganisms, with extended spectrum beta-lactamases (ESBL)-expressing Escherichia coli being the most common in asylum seeker patients admitted in a tertiary care University hospital in The Netherlands [8]
In total 1071 asylum seekers were included in the study of which 973 had methicillin resistant Staphylococcus aureus (MRSA) screening cultures or S.aureus in one or more clinical cultures and 859 had multidrug-resistant Enterobacteriaceae (MDRE) screening cultures or at least one of the enterobacteriaceae in clinical cultures
Summary
The Netherlands has a low prevalence of multidrug-resistant organisms (MDRO) compared to other countries in Europe. To prevent transmission of MRSA, the Netherlands uses a “search and destroy” policy [2] This policy includes screening of patients from high risk groups, strict isolation at admission of patients suspected to be colonized with MRSA until cultures are shown to be negative, and eradication treatment of MRSA [3,4,5]. This strategy was proven to be cost-effective and results in less death due to a bacteraemia [6]
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