Controversies in guidelines for the control of multidrug-resistant Gram-negative bacteria in EU countries

Abstract

The various guidelines that are available for multidrug-resistant Gram-negative bacteria are useful, and contain broad areas of agreement. However, there are also important areas of controversy between the guidelines in terms of the details of applying contact precautions, single-room isolation and active surveillance cultures, differences in the approach to environmental cleaning and disinfection, and whether or not to perform staff and patient cohorting, healthcare worker screening or patient decolonization. The evidence-base is extremely limited and further research is urgently required to inform an evidence-based approach to multidrug-resistant Gram-negative bacteria prevention and control.

Antimicrobial resistant Klebsiella pneumoniae carriage and infection in specialized geriatric care wards linked to acquisition in the referring hospital

“…While two of the three patients with MDR infections were not screened, given the strong evidence that they acquired their infecting strain (ESBL ST29) in the referring hospital (Figure 2) it is likely that they would have been detected as ESBL carriers if they had been swabbed on arrival. Surveillance swabs are frequently recommended to screen for carriage of MDR organisms in a variety of settings [37][38][39], but their role in the management of ESBL or CP Gram negative infections outside of outbreaks remains controversial [40]. Our study suggests that screening upon transfer from tertiary referral hospitals to specialized hospitals could be valuable for management or prevention of MDR infections.…”

Infection prevention and control in Europe – the picture in the mosaic

“…Therefore leadership needs to be involved in coordinated actions at international, national and facility levels using multidisciplinary approaches [3]. Another interesting aspect is shown by Otter et al who analyse areas of agreement and disagreement among existing guidelines for control of multidrug-resistant gram-negative bacteria [4]. Albeit that those guidelines contain broad areas of agreement and are certainly useful, the evidence-base is extremely limited and further research is urgently required [4].…”

“…Another interesting aspect is shown by Otter et al who analyse areas of agreement and disagreement among existing guidelines for control of multidrug-resistant gram-negative bacteria [4]. Albeit that those guidelines contain broad areas of agreement and are certainly useful, the evidence-base is extremely limited and further research is urgently required [4]. All the authors agree that the lack of adequate and standardized education in IPC in European countries plays a crucial role in the steady increase of multidrug-resistant organisms.…”

Screening and contact precautions – A survey on infection control measures for multidrug-resistant bacteria in German university hospitals

“…Secondly, the complexity of many recommendations promotes different interpretations of existing standards in clinical practice – probably also explaining the inconsistencies within one institution. Thirdly, the evidence for infection control measures is contradictory in the case of MRSA [10] and scarce in the case of ESBL-E and VRE [2, 3] undermining guideline adherence.…”

“…Namely, extended-spectrum ß-lactamase producing Enterobacteriaceae (ESBL-E), vancomycin-resistant Enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are subject of various studies in the field evaluating screening policies, contact precautions and decolonisation practices. Yet, results are often contradictory and the evidence regarding the effectiveness of different infection control measures remains inconclusive [1–3]. In Germany, infection control guidelines of the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch-Institute (KRINKO) exist for MRSA [4] and ESBL-E [5], but not VRE.…”