Burden of disease associated with antimicrobial resistance : studies on bloodstream infections and clinical outcomes in European hospitals

Ziekmakende bacteriën zijn door excessief gebruik van antibiotica resistent geworden voor veel van de beschikbare antibiotica. Om vast te stellen wat voor impact antibiotica-resistentie heeft, is er in het BURDEN project patiënteninformatie verzameld uit dertien verschillende ziekenhuizen verspreid door Europa. Er is hierbij specifiek gekeken naar methicillin resistente Staphylococcus aureus, MRSA, en derde-generatie-cephalosporine-resistente Escherichia coli. Patiënten met bloedbaan infecties veroorzaakt door deze multi-resistente pathogenen overleden vaker en hadden een langere opnameduur dan patiënten geïnfecteerd door gevoelige bacteriën. In 2007 zijn er binnen Europa meer dan 8,000 patiënten gestorven aan deze resistente infecties. Dit betekent dat ongeveer twee mensen per 100,000 inwoners overlijden ten gevolge van deze resistente bacteriën. Aangezien het aantal infecties veroorzaakt door gevoelige bacteriën veel hoger is, overlijden er twee keer zoveel mensen aan antibiotica-gevoelige infecties. Voor chronische ziekten, zoals hart- en vaatziekten ligt dat getal nog veel hoger (373 overlijdens per 100,000 inwoners). Het aantal bloedbaan infecties is wel sterk toegenomen door de opkomst en verspreiding van antibioticaresistentie. Dit wordt vooral veroorzaakt door resistentie ontwikkeling bij bacteriën die normaal in de darmen vóórkomen. Het is daarom wel belangrijk resistentie ontwikkeling in de gaten te blijven houden. Er zijn ook steeds vaker ziekenhuisuitbraken met bijna onbehandelbare infecties veroorzaakt door carbapenemase-producerende bacteriën. Een voorbeeld hiervan is de OXA-48 positieve Klebsiella pneumoniae in het Maasstad ziekenhuis in Rotterdam in 2011. Toekomstig onderzoek zal moeten bepalen wat voor gevolgen deze soort uitbraken hebben en hoe ze voorkómen kunnen worden. Through the excessive use of antibiotics, disease-causing bacteria have become resistant to many of the available antimicrobial drugs. In the BURDEN project, patient data was collected from thirteen hospitals across Europe to determine the clinical impact of antimicrobial resistance. The study specifically focused on methicillin resistant Staphylococcus aureus, MRSA, and third-generation-cephalosporin-resistant Escherichia coli. Patient with bloodstream infections caused by these multi-resistant pathogens died more often and had a prolonged hospital admission compared to patients infected by susceptible bacteria. In Europe, in 2007, more than 8,000 patients died due to these resistant infections, which translates to about two persons per 100,000 inhabitants. However, since infections by susceptible bacteria are more common, the number of deaths due to susceptible infections is twice as high. Chronic diseases, like cardiovascular disease, easily outweigh these figures (373 deaths per 100,000). The number of bloodstream infections did markedly increase through the emergence and spread of antimicrobial resistance. This is mainly associated with resistance development among bacteria that are present in the normal human gut flora. It therefore remains important to monitor resistance development. At the same time, more and more hospitals are faced with outbreaks of near-to-untreatable infections caused by carbapenamase-producing bacteria. Future studies will need to define what impact these pan-resistant pathogens have and how outbreaks can be prevented.

Shining a light on ultraviolet-C disinfection: No golden promises for infection prevention

No abstract available

A randomized clinical trial on the effectiveness of a symbiotic product to decolonize patients harboring multidrug-resistant Gram-negative bacilli

Abstract INTRODUCTION: We aimed to evaluate the effectiveness of a symbiotic product to decolonize the intestinal tract of patients harboring multidrug-resistant (MDR) Gram-negative bacilli and to prevent nosocomial infections. METHODS: This was a randomized, double blind, placebo-controlled clinical trial, conducted in a tertiary-care university hospital. All adult hospitalized patients with a positive clinical culture and a positive rectal swab for any MDR Gram-negative bacilli were potentially eligible. Exclusion criteria were pregnancy, immunosuppression, and bowel obstruction/perforation. The intervention consisted of administering a symbiotic product (Lactobacillus bulgaricus, Lactobacillus rhamnosus, and fructo-oligosaccharides) twice a day for seven days via the oral/enteral route. RESULTS: Between August 1, 2012 and December 22, 2013, 116 of 275 eligible patients were allocated to treatment (n=57) and placebo (n=59). Overall, 101 patients received at least four doses of the study products and were included in the modified intention-to-treat analysis. The primary study outcome, a negative rectal swab for MDR Gram-negative bacilli after treatment, was identified in 16.7% (8/48) and 20.7% (11/53) of patients in the experimental and placebo group, respectively (p=0.60). The secondary outcome, the combined incidence of nosocomial respiratory and urinary tract infections, was 37.5% (18/48) in the experimental group versus 22.6% (12/53) in the control group (adjusted odds ratio: 1.95, 95% confidence interval: 0.69-5.50, p=0.21). Length of stay after the beginning of the intervention, incidence of adverse events, and in-hospital mortality rates were similar in both study groups. CONCLUSIONS: Under the present study conditions, symbiotic administration was not effective for decolonizing hospitalized patients harboring MDR Gram-negative bacilli