Abstract：
BackgroundAntimicrobial 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.AimThe 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.MethodsBetween 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.ResultsA 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).ConclusionsThis 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.
摘要：
背景抗菌素耐药性对医疗保健构成风险，在社区和医院。多药耐药生物（MDRO）的传播主要发生在地方和区域层面，随着病人的运动，但也发生在跨国界。目的这项观察性研究的目的是确定欧洲跨境地区MDRO的患病率，以了解差异并根据实时常规数据和工作流程改善感染预防。方法2017年9月至2018年6月，荷兰（NL）-德国（DE）跨境地区（BR）的23家医院参与研究。连续8周,在入住重症监护病房（ICU）时，对患者进行了抗甲氧西林金黄色葡萄球菌（MRSA）的鼻腔携带和耐万古霉素的屎肠球菌/E的直肠携带。粪便（VRE），第三代头孢菌素耐药肠杆菌科（3GCRE）和碳青霉烯耐药肠杆菌科（CRE）。所有样品均在相关实验室进行处理。结果共筛选3,365例患者（中位年龄：68岁（IQR：57-77）；男女比例：59.7/40.3；NL-BR：n=1,202；DE-BR：n=2,163）。中位筛查依从性为60.4%(NL-BR:56.9%;DE-BR:62.9%)。DE-BR的MDRO患病率高于NL-BR，即MRSA的1.7%和0.6%(p=0.006)，VRE为2.7%vs0.1%（p<0.001），3GCRE为6.6%vs3.6%（p<0.001），而CRE患病率相当(DE-BR为0.2%,NL-BRICU为0.0%)。结论这项在欧洲跨境地区进行的首次前瞻性多中心筛查研究显示，NL-BR和DE-BRICU中MDRO携带患病率存在高度异质性。这表明患病率可能受到不同医疗保健结构的影响。
