Prevention and Control of Multidrug-Resistant Bacteria in The Netherlands and Germany—The Impact of Healthcare Structures

Köck, Robin; Becker, Karsten; Idelevich, Evgeny A.; Jurke, A; Glasner, Corinna; Hendrix, Ron

doi:10.3390/ijerph17072337

Cited by 10 publications

(16 citation statements)

References 16 publications

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“…Kock et al indicated that these differences can result from differences in the density of in-patient care, density of hospital personnel, rate of ambulatory surgery, or average length of hospitalization. All these parameters can vary significantly even between neighboring countries [33]. However, significant differences between hospitals are described also within one country, as Kreidl et al described for two hospitals in Austria [34].…”

Section: Every Fifth Bacterial Infection Diagnosed In the Analyzed Period Was Of Mdr Aetiologymentioning

confidence: 98%

Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland

Poletajew

Pawlik²,

Bonder-Nowicka

et al. 2021

Antibiotics

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Global and local initiatives were recently undertaken to reduce the burden of antibiotic resistance. The aim of the study was to describe the incidence and the aetiology of bacterial infections among hospitalized patients with special attention paid to the multidrug resistant (MDR) bacteria. This retrospective study was based on prospectively collected data from 150,529 consecutive patients hospitalized in a tertiary multidisciplinary hospital in the years 2017–2019. All consecutive microbiological tests from any biological material performed in the analyzed period were included. Microbiological screening tests (n = 10,677) were excluded. The analysis was focused on aetiological factors of bacterial infections, especially the incidence of MDR bacteria and mechanisms of antibiotic resistance. There were 58,789 microbiological tests performed in the analyzed period. The highest testing rate was noticed for intensive care unit (mean of 3.1 tests per one patient), followed by neonatal intensive care unit (2.7), internal medicine (1.9), pediatrics (1.8), and urology (1.2). Among 58,789 tests, 7690 (13.1%) were positive. MDR bacteria were responsible for 1783 infections (23.2%). The most common antibiotic resistance mechanism reported was ESBL production by Klebsiella spp. or Escherichia coli or Enterobacter spp. isolates (47.3% of all MDR cases). ESBL cases were followed by MRSA (14.7%), VRE (14.2%) and MBL producing Klebsiella spp. (5.6%). Among all infections caused by MDR bacteria, 1175 (65.9%) were diagnosed after 72 h of hospitalization (hospital-acquired infections). Apart from AmpC and ESBL producing Escherichia coli, all MDR bacteria were significantly more common in hospital-acquired infection. MDR bacteria are aetiological factors of a significant portion of infections in hospitalized patients with no remarkable change in the incidence in recent years. Production of ESBL is the most common mechanism of antibiotic resistance and should be regarded as one of the most urgent problems in clinical microbiology.

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Section: Every Fifth Bacterial Infection Diagnosed In the Analyzed Period Was Of Mdr Aetiologymentioning

confidence: 98%

Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland

Poletajew

Pawlik²,

Bonder-Nowicka

et al. 2021

Antibiotics

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“…The reasons for this are (i) the emergence of novel pathogens as currently experienced with SARS-CoV-2 [ 5 ], (ii) the selection and global spread of multidrug-resistant organisms (MDROs) [ 6 , 7 , 8 , 9 , 10 ], (iii) the medical progress characterized by the increased application of immune system-impairing procedures and colonization-vulnerable devices [ 11 , 12 , 13 , 14 , 15 , 16 ], (iv) the demographic changes leading to higher susceptibility of subpopulations to infectious diseases, such as the increase of older and multi-morbid individuals [ 17 , 18 , 19 ] and (v) the migration and lifestyle aspects leading to the transmission and distribution of MDROs [ 20 , 21 , 22 ]. Emerging clonal lineages of notorious MDROs with changed epidemiology and host spectra (e.g., community- and livestock-associated MRSA and hypervirulent, multi-resistant Klebsiella pneumoniae lineages) also add to the burden of diseases, necessitating health behavior programs [ 6 , 9 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany

et al. 2022

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Hand hygiene is a cornerstone of infection prevention. However, few data are available for school children on their knowledge of infectious diseases and their prevention. The aim of the study was to develop and apply a standardized questionnaire for children when visiting primary schools to survey their knowledge about infectious diseases, pathogen transmission and prevention measures. Enrolling thirteen German primary schools, 493 questionnaires for grade three primary school children were included for further analyses, comprising 257 (52.1%) girls and 236 (47.9%) boys with an age range of 8–11 years. Out of 489 children, 91.2% participants indicated that they knew about human-to-human transmissible diseases. Of these, 445 children responded in detail, most frequently mentioning respiratory and gastrointestinal diseases, followed by childhood diseases. Addressing putative hygiene awareness-influencing factors, it was worrisome that more than 40.0% of the children avoided visiting the sanitary facilities at school. Most of the children (82.9%) noted that they did not like to use the sanitary facilities at school because of their uncleanliness and the poor hygienic behavior of their classmates. In conclusion, basic infection awareness exists already in primary school age children. Ideas about the origin and prevention of infections are retrievable, however, this knowledge is not always accurate and adequately contextualized. Since the condition of sanitary facilities has a strong influence on usage behavior, the child’s perspective should be given more consideration in the design and maintenance of sanitary facilities.

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“…hospital activity, size, staff availability, hospital geography and inter-hospital distance. A recent report highlighted that a higher density of inpatient care, a higher number of hospitals, a longer length of stay and lower staffing ratios all might facilitate MDRO dissemination [ 31 ]. Interestingly, when comparing the hospital types between the two border regions, the university hospitals had a very similar prevalence of all MDROs on ICUs.…”

Section: Discussionmentioning

confidence: 99%

A prospective multicentre screening study on multidrug-resistant organisms in intensive care units in the Dutch–German cross-border region, 2017 to 2018: the importance of healthcare structures

et al. 2022

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Background Antimicrobial 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. Aim The 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. Methods Between 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. Results A 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). Conclusions This 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.

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Prevention and Control of Multidrug-Resistant Bacteria in The Netherlands and Germany—The Impact of Healthcare Structures

Cited by 10 publications

References 16 publications

Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland

Multi-Drug Resistant Bacteria as Aetiological Factors of Infections in a Tertiary Multidisciplinary Hospital in Poland

Knowledge about Hand Hygiene and Related Infectious Disease Awareness among Primary School Children in Germany

A prospective multicentre screening study on multidrug-resistant organisms in intensive care units in the Dutch–German cross-border region, 2017 to 2018: the importance of healthcare structures

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