What's in a name : name suppression and the need for public interest

OBJECTIVES: Following two studies conducted in 2005 and 2011, a third prevalence survey of multidrug-resistant microorganisms (MDRO) was organised in Belgian nursing homes (NHs) using a similar methodology. The aim was to measure the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) in NH residents. Risk factors for MDRO carriage were also explored. METHODS: Up to 51 randomly selected residents per NH were screened for MDRO carriage by trained local nurses between June and October 2015. Rectal swabs were cultured for ESBLE, CPE and VRE, while pooled samples of nose, throat and perineum and chronic wound swabs were obtained for culture of MRSA. Antimicrobial susceptibility testing, molecular detection of resistance genes and strain genotyping were performed. Significant risk factors for MDRO colonization MDRO was determined by univariate and multivariable analysis. RESULTS: Overall, 1447 residents from 29 NHs were enrolled. The mean weighted prevalence of ESBLE and MRSA colonization was 11.3% and 9.0%, respectively. Co-colonization occurred in 1.8% of the residents. VRE and CPE carriage were identified in only one resident each. Impaired mobility and recent treatment with fluoroquinolones or with combinations of sulphonamides and trimethoprim were identified as risk factors for ESBLE carriage, while for MRSA these were previous MRSA carriage/infection, a stay in several different hospital wards during the past year, and a recent treatment with nitrofuran derivatives. Current antacid use was a predictor for both ESBL and MRSA carriage. CONCLUSIONS: In line with the evolution of MRSA and ESBL colonization/infection in hospitals, a decline in MRSA carriage and an increase in ESBLE prevalence was seen in Belgian NHs between 2005 and 2015. These results show that a systemic approach, including surveillance and enhancement of infection control and antimicrobial stewardship programs is needed in both acute and chronic care facilities

Prevalence and mechanisms of resistance to carbapenems in Enterobacteriaceae

Objectives: To determine the point prevalence of carbapenem-non-susceptible Enterobacteriaceae (CNSE) and carbapenemase-producing Enterobacteriaceae (CPE) isolates among hospitalized patients in Belgium. Methods: Twenty-four hospital-based laboratories prospectively collected 200 non-duplicated Enterobacteriaceae isolates from clinical specimens of hospitalized patients over a 2 month period. All isolates were screened locally for decreased susceptibility to carbapenem drugs using a disc diffusion method according to CLSI interpretative criteria. CNSE strains were referred centrally for confirmation of carbapenemase by phenotypic and molecular testing. Results: From February to April 2012, 158 of the 4564 screened Enterobacteriaceae isolates were categorized as non-susceptible to carbapenems, resulting in a point prevalence of CNSE of 3.5% (95% CI: 2.9%–4.2%; range per centre: 0.5%–8.5%). Of the 125 referred CNSE isolates, 11 Klebsiella pneumoniae isolates [OXA-48 (n=7), KPC type (n=3) and NDM type (n=1)], 1 OXA-48-positive Escherichia coli isolate and 1 KPC-positive Klebsiella oxytoca isolate were detected in eight hospitals. None of the 72 carbapenem-non-susceptible Enterobacter spp. isolates were confirmed as CPE. The minimal estimated point prevalence of CPE isolates was 0.28% (13/ 4564; 95% CI: 0.13%–0.44%) overall (range per centre: 0%–1.5%). Conclusions: Despite the overall low prevalence of CNSE found in this study, the detection of CPE isolates in one-third of the participating centres raises concerns and highly suggests the spread and establishment of CPE in Belgian hospitals

Evaluation of gas-liquid chromatography (GLC) for rapid detection of Clostridium difficile in fecal specimens.

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Antimicrobial susceptibility among Gram-positive and Gram-negative isolates collected in Europe between 2004 and 2010

Here we report on the in vitro activity of a suite of antimicrobial agents against Gram-negative and Gram-positive pathogens collected in Europe between 2004 and 2010 as part of the Tigecycline Evaluation and Surveillance Trial (T.E.S.T.). Clinical and Laboratory Standards Institute (CLSI) broth microdilution methodologies were used to determine minimum inhibitory concentrations. CLSI interpretive criteria were applied for all antimicrobial agents to establish susceptibility; European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints were used for tigecycline. In total, 46,921 Gram-negative and 19,174 Gram-positive isolates were included in this study. Extended-spectrum β-lactamases increased in proportion from 15.7% to 21.1% among Klebsiella pneumoniae and from 9.7% to 16.1% among Escherichia coli isolates between 2004-2007 and 2010. E. coli susceptibility decreased to most antimicrobials but it remained highly susceptible (>98%) to tigecycline and meropenem. Acinetobacter baumannii susceptibility also decreased to most agents. The proportion of meticillin-resistant Staphylococcus aureus (MRSA) decreased from 25.7% to 19.4% over the study period. Antimicrobial susceptibility has decreased among many of the pathogens observed in the T.E.S.T. surveillance study between 2004-2007 and 2010. © 2014 International Society for Chemotherapy of Infection and Cancer.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Low prevalence of methicillin-resistant Staphylococcus aureus with reduced susceptibility to glycopeptides in Belgian hospitals

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Evaluation of New Vitek 2 Card and Disk Diffusion Method for Determining Susceptibility of Staphylococcus aureus to Oxacillin

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Evaluation of disc diffusion methods and Vitek 2 automated system for testing susceptibility to mupirocin in Staphylococcus aureus

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Emergence and spread of gentamicin-susceptible strains of methicillin-resistant Staphylococcus aureus in Belgian hospitals

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Performance of the verigene gram-negative blood culture assay for rapid detection of bacteria and resistance determinants

Nonduplicate blood cultures that were positive for Gram-negative bacilli (n = 125) were tested by the Verigene Gram-negative blood culture (BC-GN) assay; 117 (90.7%) isolates were members of the panel. For identification and resistance markers, the agreements with routine methods were 97.4% (114/117) and 92.3% (12/13). The BC-GN assay is a rapid and accurate tool for the detection of pathogens from blood cultures and could be integrated alongside conventional systems to enable faster patient management, but the clinical benefits should be further evaluated. Copyright © 2014, American Society for Microbiology. All Rights Reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Comparative epidemiology of Staphylococcus epidermidis isolated from patients with catheter-related bacteremia and from healthy volunteers.

Introduction Staphylococcus epidermidis (SE) is a major cause of catheter-related bloodstream infections (CRBSI). Recent studies suggested the existence of well adapted, highly resistant, hospital-associated SE clones. The molecular epidemiology of SE in the Belgian hospitals and community has not been explored yet.Objectives We compared a set of 33 SE isolates causing CRBSI in hospitalized patients with a set of 33 commensal SE isolates. Analyzed factors included resistance to antibiotics and genetic diversity as determined by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and SCCmec typing. Additionally, the presence of virulence-associated mobile genetic elements, the ica operon and the arginine catabolic mobile element (ACME), was assessed and confronted to clinical data.Results CRBSI SE isolates were significantly resistant to more antibiotics than commensal SE isolates. The two populations studied were very diverse and genetically distinct as only 23% of the 37 PFGE types observed were harbored by both CRBSI and commensal isolates. ACME was found in 76% of SE strains, regardless of their origin while the ica operon was significantly more prevalent in CRBSI isolates than in commensal isolates (P< 0.05). Nine patients presented a clinically severe CRBSI, eight of which were due to an ica positive multi-resistant isolate belonging to ST2 or ST54.Conclusions SE isolates causing CRBSI were more resistant and more often ica positive than commensal SE isolates, that were genetically heterogeneous and susceptible to the majority of antibiotics tested. Clinically severe CRBSI were due to isolates belonging to two closely related MLST types, ST2 and ST54.JOURNAL ARTICLESCOPUS: ar.jinfo:eu-repo/semantics/publishe