Influx of multidrug-resistant organisms by country-to-country transfer of patients

BMC Infectious Diseases

Uwe Frank³  Alexander Mischnik¹  Anja Sander²  Frank Günther³  Nico T. Mutters¹ 

[1] German Center for Infection Research, Heidelberg University Hospital, Heidelberg, Germany;Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, Heidelberg, D-69120, Germany

关键词: Carbapenemase;    Multidrug-resistant organisms;    Infection control;    Healthcare-associated infections;   

Others  :  1232746
DOI  :  10.1186/s12879-015-1173-8

 received in 2015-04-01, accepted in 2015-10-02,  发布年份 2015

【 摘 要 】

Background

Multidrug-resistant organisms (MDRO) are a worldwide problem. International migration and travel facilitate the spread of MDRO. Therefore the goal of our study was to assess the risk of influx of MDRO from patients transferred to one of Central Europe’s largest hospitals from abroad.

Methods

A mono-centre study was conducted. All patients transferred from other countries were screened; additional data was collected on comorbidities, etc. Presence of carbapenemases of multidrug-resistant Gram-negatives was confirmed by PCR. The association between length of stay, being colonized and/or infected by a MDRO, country of origin, diagnosis and other factors was assessed by binomial regression analyses.

Results

From 2012 to 2013, one fifth of all patients were colonized with MDRO (Methicillin-resistant Staphylococcus aureus [4.1 %], Vancomycin-resistant Enterococci [2.9 %], multidrug-resistant Gram-negatives [12.8 %] and extensively drug-resistant Gram-negatives [3.4 %]). The Gram-negatives carried a variety of carbapenemases including OXA, VIM, KPC and NDM. The length of stay was significantly prolonged by 77.2 % in patients colonized with a MDRO, compared to those not colonized (p<0.0001).

Conclusions

Country-to-Country transfer of patients to European hospitals represents a high risk of introduction of MDRO and infection control specialists should endorse containment and screening measures.

【 授权许可】

   
2015 Mutters et al.

【 参考文献 】

• [1]Centers-for-Disease-Control-and-Prevention: Antibiotic Resistance Threats in the United States. Edited by CDC: CDC; 2013: 1–114.
• [2]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.
• [3]Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J et al.. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010; 15(41):19688.
• [4]Johnson AP. Methicillin-resistant Staphylococcus aureus: the European landscape. J Antimicrob Chemother. 2011; 66 Suppl 4:iv43-iv48.
• [5]Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN et al.. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis. 2001; 32 Suppl 2:S114-132.
• [6]Molton JS, Tambyah PA, Ang BS, Ling ML, Fisher DA. The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia. Clin Infect Dis. 2013; 56(9):1310-1318.
• [7]Mutters NT, Brooke RJ, Frank U, Heeg K. Low risk of apparent transmission of vancomycin-resistant Enterococci from bacteraemic patients to hospitalized contacts. Am J Infect Control. 2013; 41(9):778-781.
• [8]Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA et al.. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008; 29(11):996-1011.
• [9]Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A et al.. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 2008; 13(47):1-11.
• [10]Nordmann P, Dortet L, Poirel L. Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends in molecular medicine. 2012; 18(5):263-272.
• [11]Rolain JM, Parola P, Cornaglia G. New Delhi metallo-beta-lactamase (NDM-1): towards a new pandemia? Clin Microbiol Infect. 2010; 16(12):1699-1701.
• [12]Drew RJ, Turton JF, Hill RL, Livermore DM, Woodford N, Paulus S et al.. Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital. J Hosp Infect. 2013; 84(4):300-304.
• [13]Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014; 20(9):821-830.
• [14]Eigner U, Holfelder M, Oberdorfer K, Betz-Wild U, Bertsch D, Fahr AM. Performance of a matrix-assisted laser desorption ionization-time-of-flight mass spectrometry system for the identification of bacterial isolates in the clinical routine laboratory. Clin Lab. 2009; 55(7–8):289-296.
• [15]Hofko M, Mischnik A, Kaase M, Zimmermann S, Dalpke AH. Detection of carbapenemases by real-time PCR and melt curve analysis on the BD Max system. J Clin Microbiol. 2014; 52(5):1701-1704.
• [16]Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG et al.. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2011; 18(3):268-81.
• [17]Harmsen D, Claus H, Witte W, Rothganger J, Claus H, Turnwald D et al.. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003; 41(12):5442-5448.
• [18]Wendt C, Schutt S, Dalpke AH, Konrad M, Mieth M, Trierweiler-Hauke B et al.. First outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany. Eur J Clin Microbiol Infect Dis. 2010; 29(5):563-570.
• [19]Moro M, Nizzero P, Biancardi A, Baldan R, Scarpellini P, Curti C et al.. An outbreak caused by multidrug-resistant OXA-58-positive Acinetobacter baumannii in an intensive care unit in Italy. J Hosp Infect. 2008; 68(1):97-99.
• [20]Ben-David D, Kordevani R, Keller N, Tal I, Marzel A, Gal-Mor O et al.. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect. 2012; 18(1):54-60.
• [21]Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sanchez-Ortega I et al.. Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother. 2011; 66(3):657-663.
• [22]Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008; 29(12):1099-1106.
• [23]Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother. 2008; 52(3):1028-1033.
• [24]Russell DL, Flood A, Zaroda TE, Acosta C, Riley MM, Busuttil RW et al.. Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant. 2008; 8(8):1737-1743.
• [25]Niven DJ, Laupland KB, Gregson DB, Church DL. Epidemiology of Staphylococcus aureus nasal colonization and influence on outcome in the critically ill. J Crit Care. 2009; 24(4):583-589.
• [26]Nemeth J, Ledergerber B, Preiswerk B, Nobile A, Karrer S, Ruef C et al.. Multidrug-resistant bacteria in travellers hospitalized abroad: prevalence, characteristics, and influence on clinical outcome. J Hosp Infect. 2012; 82(4):254-259.