Cross-border comparison of the Dutch and German guidelines on multidrug-resistant Gram-negative microorganisms

Abstract

BackgroundIn all European countries, hospital-acquired infections caused by Gram-negative multidrug-resistant microorganisms (GN-MDRO) are a major health threat, as these pathogens cannot be adequately treated anymore, or the start of effective antibiotic treatment is delayed. The efforts to limit the selection and spread of GN-MDRO remains a problem in cross-border healthcare, as the national guidelines on hygiene standards applicable for patients colonized or infected with GN-MDRO in hospitals are not harmonized between European countries.MethodsIn order to point out the similarities and differences in the national guidelines of Germany and The Netherlands regarding GN-MDRO, guidelines were compared and an expert workshop was organized by the INTERREG IVa project EurSafety Health-net.ResultsBoth guidelines divide the Gram-negative organisms into subgroups based on bacterial species and antibiotic susceptibility patterns in order to define multidrug-resistant variants of these bacteria. However, the Dutch guideline defines that GN-MDRO Enterobacteriaceae requires testing for certain mechanisms causing antibiotic resistance, whereas the German guideline makes use of a newly created classification scheme, based on phenotypic characterization. Besides diagnostic issues, the main difference between the Dutch and German guideline is the divergent evaluation of ESBL-producing Enterobacteriaceae. Special hygiene measures are required for all patients with ESBL-producing Enterobacteriaceae in The Netherlands, whereas the German guideline recommends special precautions only for those cases in which patients are colonized or infected with strains showing co-resistance to ciprofloxacin (“3MRGN”).ConclusionsThe usage of consistent terminology and harmonized diagnostic procedures would improve the possibilities for infection prevention, treatment and patient safety. Prevention of severe non-treatable infections and outbreaks due to MDRO, caused by an increased population seeking medical treatment abroad together with an increased number of highly susceptible individuals demands gathering of regional data, and data comparable between the two sides of the Dutch-German border. The necessity to cooperate multidisciplinary and across borders is required to prevent a post-antibiotic era – in which common infections and minor injuries may lead to death.

Patient engagement with surgical site infection prevention: an expert panel perspective

“…Thus emphasizing the importance of surveillance and adherence to infection prevention and control policies for these patients [52, 53]. Of note, admission screening of patients at high risk of MDRO carriage (e.g.…”

Defining Multidrug Resistance of Gram-Negative Bacteria in the Dutch–German Border Region—Impact of National Guidelines

“…Moreover, it is important to differentiate between MDRGNB definitions established for therapeutic decisions and those created for epidemiological purposes and infection prevention [ 4 ]. Recently, Mueller et al have pointed out differences between the Dutch and German guidelines regarding the advice they give to laboratories and infection control personnel, which Gram-negative bacteria and antimicrobial resistance patterns should be considered as MDRGNB [ 5 ]. As patient movement across the Dutch–German border is not infrequent, such divergent definitions could result in reduced patient safety, because isolates requiring isolation in the hospital abroad are not flagged as being multidrug-resistant on the microbiological reports.…”

Measuring the impact of antimicrobial stewardship programs

“…hospitals, but also general practices and long-term care facilities) within a clearly defined region [18]. Harmonization of guidelines and practices can be a first start regarding this aspect [19]. In the near future, such an integrated AID approach should lead to a more personalized treatment plan, which is optimally adapted to the specifics of each single patient.…”

“…Examples of POC tests or rapid diagnostics (e.g. multiplex PCR and matrixassisted laser desorption/ionization time-of-flight mass spectrometry) already implemented for ASPs are: methicillinresistant Staphylococcus aureus (MRSA) screening and testing [23][24][25]; resistance screening [26]; the use in septic/ bacteremic patients [27][28][29]; use of biomarkers (of which procalcitonin probably shows the most promising results) [30][31][32][33]; and with viral infections, such as for respiratory illness [19,34].…”