Division of Infectious Diseases and Hospital Epidemiology, and Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland.
Service d'hygiène hospitalière, Hôpitaux Universitaires de Strasbourg, France.
Swiss Med Wkly. 2021 Mar 1;151:w20454. doi: 10.4414/smw.2021.20454.
Multidrug-resistant organisms (MDROs) are a public health threat. Single-centre interventions, however, are likely to fail in the long term, as patients are commonly transferred between institutions given the economic integration across borders. A transnational approach targeting larger regions is needed to plan overarching sets of interventions. Here, we aim to describe differences in diagnostic and infection prevention and control (IPC) measures in the fight against MDROs.
In 2019, we systematically assessed diagnostic algorithms and IPC measures implemented for detection and control of MDROs at three tertiary academic care centres (Freiburg; Strasbourg; Basel). Data were collected using a standardised data collection sheet to be filled in by every centre. Uncertainties were clarified by direct contact via telephone or email with the data supplier. Internal validity was checked by at least two researchers independently filling in the survey.
All centres have established a primarily culture-based, rather than a nucleic acid amplification-based approach for detection of MDROs (i.e., vancomycin-resistant Enterococci [VRE], methicillin-resistant Staphylococcus aureus [MRSA], extended-spectrum beta-lactamase-producing Enterobacteriaceae [ESBL], carbapenemase-producing and carbapenem-resistant Gram-negatives [CPGN/CRGN]). IPC measures differed greatly across all centres. High-risk patients are screened for most MDROs on intensive care unit (ICU) admission in all centres; only the French centre is screening all patients admitted to the ICU for VRE, MRSA and ESBL. Patients colonised/infected by MRSA, quinolone-resistant ESBL Klebsiella spp. and CPGN/CRGN are isolated everywhere, whereas patients colonised/infected by VRE and ESBL are usually not isolated in the German centre.
In contrast to the French and Swiss centres, the German centre no longer uses isolation measures to control VRE and quinolone-susceptible ESBL. Overall, the French centre is more focused on intercepting MDRO transmission from outside, whereas the German and Swiss centres are more focused on intercepting endemic MDRO transmission. These findings point to important challenges regarding future attempts to standardise IPC measures across borders.  .
多重耐药菌（MDRO）是公共卫生威胁。然而，由于患者经常在机构之间转移，以实现跨境经济一体化，单一中心的干预措施从长期来看可能会失败。需要采取跨国方法针对更大的地区，以规划全面的干预措施。在这里，我们旨在描述在对抗 MDRO 方面诊断和感染预防与控制（IPC）措施的差异。
2019 年，我们系统地评估了三家三级学术护理中心（弗赖堡、斯特拉斯堡、巴塞尔）在检测和控制 MDRO 方面实施的诊断算法和 IPC 措施。使用标准化数据收集表收集数据，由每个中心填写。通过与数据提供者直接电话或电子邮件联系，澄清了不确定之处。内部有效性由至少两名研究人员独立填写调查进行检查。
所有中心都建立了主要基于培养的方法，而不是基于核酸扩增的方法来检测 MDRO（即万古霉素耐药肠球菌[VRE]、耐甲氧西林金黄色葡萄球菌[MRSA]、产超广谱β-内酰胺酶的肠杆菌科[ESBL]、产碳青霉烯酶和耐碳青霉烯的革兰氏阴性菌[CPGN/CRGN]）。IPC 措施在所有中心之间差异很大。所有中心在 ICU 入院时都对大多数 MDRO 进行高危患者筛查；只有法国中心对所有 ICU 入院患者进行 VRE、MRSA 和 ESBL 筛查。MRSA、喹诺酮类耐药 ESBL 肺炎克雷伯菌和 CPGN/CRGN 定植/感染的患者在所有地方都被隔离，而 VRE 和 ESBL 定植/感染的患者在德国中心通常不被隔离。
与法国和瑞士中心相比，德国中心不再使用隔离措施来控制 VRE 和对喹诺酮敏感的 ESBL。总体而言，法国中心更注重从外部拦截 MDRO 传播，而德国和瑞士中心更注重拦截地方性 MDRO 传播。这些发现表明，在未来试图跨越国界标准化 IPC 措施方面存在重要挑战。
