Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 151 No. 0910 (2021)

Differences in infection control and diagnostic measures for multidrug-resistant organisms in the tristate area of France, Germany and Switzerland in 2019 – survey results from the RH(E)IN-CARE network

DOI
https://doi.org/10.4414/smw.2021.20454
Cite this as:
Swiss Med Wkly. 2021;151:w20454
Published
01.03.2021

Summary

BACKGROUND

Multidrug-resistant organisms (MDROs) are a public health threat. Single-centre interventions, however, are likely to fail in the long term, as patients are commonly transferred between institutions given the economic integration across borders. A transnational approach targeting larger regions is needed to plan overarching sets of interventions. Here, we aim to describe differences in diagnostic and infection prevention and control (IPC) measures in the fight against MDROs.

METHODS

In 2019, we systematically assessed diagnostic algorithms and IPC measures implemented for detection and control of MDROs at three tertiary academic care centres (Freiburg; Strasbourg; Basel). Data were collected using a standardised data collection sheet to be filled in by every centre. Uncertainties were clarified by direct contact via telephone or email with the data supplier. Internal validity was checked by at least two researchers independently filling in the survey.

RESULTS

All centres have established a primarily culture-based, rather than a nucleic acid amplification-based approach for detection of MDROs (i.e., vancomycin-resistant Enterococci [VRE], methicillin-resistant Staphylococcus aureus [MRSA], extended-spectrum beta-lactamase-producing Enterobacteriaceae [ESBL], carbapenemase-producing and carbapenem-resistant Gram-negatives [CPGN/CRGN]). IPC measures differed greatly across all centres. High-risk patients are screened for most MDROs on intensive care unit (ICU) admission in all centres; only the French centre is screening all patients admitted to the ICU for VRE, MRSA and ESBL. Patients colonised/infected by MRSA, quinolone-resistant ESBL Klebsiella spp. and CPGN/CRGN are isolated everywhere, whereas patients colonised/infected by VRE and ESBL are usually not isolated in the German centre.

CONCLUSIONS

In contrast to the French and Swiss centres, the German centre no longer uses isolation measures to control VRE and quinolone-susceptible ESBL. Overall, the French centre is more focused on intercepting MDRO transmission from outside, whereas the German and Swiss centres are more focused on intercepting endemic MDRO transmission. These findings point to important challenges regarding future attempts to standardise IPC measures across borders.

References

  1. Prestinaci F, Pezzotti P, Pantosti A. Antimicrobial resistance: a global multifaceted phenomenon. Pathog Glob Health. 2015;109(7):309–18. doi:.https://doi.org/10.1179/2047773215Y.0000000030
  2. Neubeiser A, Bonsignore M, Tafelski S, Alefelder C, Schwegmann K, Rüden H, et al. Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals. J Infect Public Health. 2020;13(2):204–10. doi:.https://doi.org/10.1016/j.jiph.2019.07.025
  3. Cassini A, Plachouras D, Eckmanns T, Abu Sin M, Blank HP, Ducomble T, et al. Burden of Six Healthcare-Associated Infections on European Population Health: Estimating Incidence-Based Disability-Adjusted Life Years through a Population Prevalence-Based Modelling Study. PLoS Med. 2016;13(10):e1002150. doi:.https://doi.org/10.1371/journal.pmed.1002150
  4. Maechler F, Geffers C, Schwab F, Peña Diaz LA, Behnke M, Gastmeier P. Entwicklung der Resistenzsituation in Deutschland [Development of antimicrobial resistance in Germany]. Med Klin Intensivmed Notf Med. 2017;112(3):186–91. Article in German. doi:.https://doi.org/10.1007/s00063-017-0272-2
  5. Behnke M, Aghdassi SJ, Hansen S, Diaz LAP, Gastmeier P, Piening B. The Prevalence of Nosocomial Infection and Antibiotic Use in German Hospitals. Dtsch Arztebl Int. 2017;114(50):851–7. doi:.https://doi.org/10.3238/arztebl.2017.0851
  6. Meyer E, Gastmeier P, Deja M, Schwab F. Antibiotic consumption and resistance: data from Europe and Germany. Int J Med Microbiol. 2013;303(6-7):388–95. doi:.https://doi.org/10.1016/j.ijmm.2013.04.004
  7. Spiga R, Subtil F, Grattard F, Fascia P, Mariat C, Auboyer C, et al. Hospital-acquired infections documented by repeated annual prevalence surveys over 15 years. Med Mal Infect. 2018;48(2):136–40. doi:.https://doi.org/10.1016/j.medmal.2017.11.008
  8. Carbonne A, Arnaud I, Maugat S, Marty N, Dumartin C, Bertrand X, et al.; MDRB Surveillance National Steering Group (BMR-Raisin). National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: a 9 year experience. J Antimicrob Chemother. 2013;68(4):954–9. doi:.https://doi.org/10.1093/jac/dks464
  9. Zingg W, Metsini A, Balmelli C, Neofytos D, Behnke M, Gardiol C, et al.; On Behalf Of The Swissnoso Network. National point prevalence survey on healthcare-associated infections in acute care hospitals, Switzerland, 2017. Euro Surveill. 2019;24(32). doi:.https://doi.org/10.2807/1560-7917.ES.2019.24.32.1800603
  10. Mutters NT, Günther F, Sander A, Mischnik A, Frank U. Influx of multidrug-resistant organisms by country-to-country transfer of patients. BMC Infect Dis. 2015;15(1):466. doi:.https://doi.org/10.1186/s12879-015-1173-8
  11. Biehl LM, Bertz H, Bogner J, Dobermann UH, Kessel J, Krämer C, et al. Screening and contact precautions - A survey on infection control measures for multidrug-resistant bacteria in German university hospitals. Antimicrob Resist Infect Control. 2017;6(1):37. doi:.https://doi.org/10.1186/s13756-017-0191-2
  12. Aghdassi SJS, Hansen S, Bischoff P, Behnke M, Gastmeier P. A national survey on the implementation of key infection prevention and control structures in German hospitals: results from 736 hospitals conducting the WHO Infection Prevention and Control Assessment Framework (IPCAF). Antimicrob Resist Infect Control. 2019;8(1):73. doi:.https://doi.org/10.1186/s13756-019-0532-4
  13. Martischang R, Buetti N, Balmelli C, Saam M, Widmer A, Harbarth S. Nation-wide survey of screening practices to detect carriers of multi-drug resistant organisms upon admission to Swiss healthcare institutions. Antimicrob Resist Infect Control. 2019;8(1):37. doi:.https://doi.org/10.1186/s13756-019-0479-5
  14. Mutters NT, Tacconelli E. Infection prevention and control in Europe - the picture in the mosaic. Clin Microbiol Infect. 2015;21(12):1045–6. doi:.https://doi.org/10.1016/j.cmi.2015.06.012
  15. Tacconelli E, Buhl M, Humphreys H, Malek V, Presterl E, Rodriguez-Baño J, et al.; EUCIC StopNegative group. Analysis of the challenges in implementing guidelines to prevent the spread of multidrug-resistant gram-negatives in Europe. BMJ Open. 2019;9(5):e027683. doi:.https://doi.org/10.1136/bmjopen-2018-027683
  16. Wanted: a reward for antibiotic development. Nat Biotechnol. 2018;36(7):555. doi:.https://doi.org/10.1038/nbt.4193
  17. Köck R, Siemer P, Esser J, Kampmeier S, Berends MS, Glasner C, et al. Defining Multidrug Resistance of Gram-Negative Bacteria in the Dutch-German Border Region-Impact of National Guidelines. Microorganisms. 2018;6(1):11. doi:.https://doi.org/10.3390/microorganisms6010011
  18. Tschudin-Sutter S, Lucet JC, Mutters NT, Tacconelli E, Zahar JR, Harbarth S. Contact Precautions for Preventing Nosocomial Transmission of Extended-Spectrum β Lactamase-Producing Escherichia coli: A Point/Counterpoint Review. Clin Infect Dis. 2017;65(2):342–7. doi:.https://doi.org/10.1093/cid/cix258
  19. Mutters NT, Heeg K, Späth I, Henny N, Günther F. Improvement of infection control management by routine molecular evaluation of pathogen clusters. Diagn Microbiol Infect Dis. 2017;88(1):82–7. doi:.https://doi.org/10.1016/j.diagmicrobio.2017.01.013
  20. Ellington MJ, Ekelund O, Aarestrup FM, Canton R, Doumith M, Giske C, et al. The role of whole genome sequencing in antimicrobial susceptibility testing of bacteria: report from the EUCAST Subcommittee. Clin Microbiol Infect. 2017;23(1):2–22. doi:.https://doi.org/10.1016/j.cmi.2016.11.012
  21. Jurke A, Daniels-Haardt I, Silvis W, Berends MS, Glasner C, Becker K, et al. Changing epidemiology of meticillin-resistant Staphylococcus aureus in 42 hospitals in the Dutch-German border region, 2012 to 2016: results of the search-and-follow-policy. Euro Surveill. 2019;24(15). doi:.https://doi.org/10.2807/1560-7917.ES.2019.24.15.1800244
  22. Erb S, Frei R, Dangel M, Widmer AF. Multidrug-Resistant Organisms Detected More Than 48 Hours After Hospital Admission Are Not Necessarily Hospital-Acquired. Infect Control Hosp Epidemiol. 2017;38(1):18–23. doi:.https://doi.org/10.1017/ice.2016.226
  23. Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection. Clin Infect Dis. 2011;53(1):49–56. doi:.https://doi.org/10.1093/cid/cir273
  24. Jones M, Nielson C, Gupta K, Khader K, Evans M. Collateral benefit of screening patients for methicillin-resistant Staphylococcus aureus at hospital admission: isolation of patients with multidrug-resistant gram-negative bacteria. Am J Infect Control. 2015;43(1):31–4. doi:.https://doi.org/10.1016/j.ajic.2014.09.016
  25. Engler-Hüsch S, Heister T, Mutters NT, Wolff J, Kaier K. In-hospital costs of community-acquired colonization with multidrug-resistant organisms at a German teaching hospital. BMC Health Serv Res. 2018;18(1):737. doi:.https://doi.org/10.1186/s12913-018-3549-0
  26. Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrob Resist Infect Control. 2019;8(1):35. doi:.https://doi.org/10.1186/s13756-019-0471-0
  27. Bar-Yoseph H, Hussein K, Braun E, Paul M. Natural history and decolonization strategies for ESBL/carbapenem-resistant Enterobacteriaceae carriage: systematic review and meta-analysis. J Antimicrob Chemother. 2016;71(10):2729–39. doi:.https://doi.org/10.1093/jac/dkw221
  28. Tidwell J, Kirk L, Luttrell T, Pike CA. CA-MRSA Decolonization Strategies: Do They Reduce Recurrence Rate? J Wound Ostomy Continence Nurs. 2016;43(6):577–82. doi:.https://doi.org/10.1097/WON.0000000000000277
  29. Climo MW, Yokoe DS, Warren DK, Perl TM, Bolon M, Herwaldt LA, et al. Effect of daily chlorhexidine bathing on hospital-acquired infection. N Engl J Med. 2013;368(6):533–42. doi:.https://doi.org/10.1056/NEJMoa1113849
  30. Boonyasiri A, Thaisiam P, Permpikul C, Judaeng T, Suiwongsa B, Apiradeewajeset N, et al. Effectiveness of Chlorhexidine Wipes for the Prevention of Multidrug-Resistant Bacterial Colonization and Hospital-Acquired Infections in Intensive Care Unit Patients: A Randomized Trial in Thailand. Infect Control Hosp Epidemiol. 2016;37(3):245–53. doi:.https://doi.org/10.1017/ice.2015.285

Most read articles by the same author(s)

<< < 1 2