In all European countries, hospital-acquired infections caused by Gram-negative multidrug-resistant microorganisms (GN-MDRO) are a major health threat, as these pathogens cannot be adequately treated anymore, or the start of effective antibiotic treatment is delayed. The efforts to limit the selection and spread of GN-MDRO remains a problem in cross-border healthcare, as the national guidelines on hygiene standards applicable for patients colonized or infected with GN-MDRO in hospitals are not harmonized between European countries.

Methods:
In order to point out the similarities and differences in the national guidelines of Germany and The Netherlands regarding GN-MDRO, guidelines were compared and an expert workshop was organized by the INTERREG IVa project EurSafety Health-net.

Results:
Both guidelines divide the Gram-negative organisms into subgroups based on bacterial species and antibiotic susceptibility patterns in order to define multidrug-resistant variants of these bacteria. However, the Dutch guideline defines that GN-MDROEnterobacteriaceae requires testing for certain mechanisms causing antibiotic resistance, whereas the German guideline makes use of a newly created classification scheme, based on phenotypic characterization. Besides diagnostic issues, the main difference between the Dutch and German guideline is the divergent evaluation of ESBL-producing Enterobacteriaceae. Special hygiene measures are required for all patients with ESBL-producing Enterobacteriaceae in The Netherlands, whereas the German guideline recommends special precautions only for those cases in which patients are colonized or infected with strains showing co-resistance to ciprofloxacin (“3MRGN”).

Conclusions:
The usage of consistent terminology and harmonized diagnostic procedures would improve the possibilities for infection prevention, treatment and patient safety. Prevention of severe non-treatable infections and outbreaks due to MDRO, caused by an increased population seeking medical treatment abroad together with an increased number of highly susceptible individuals demands gathering of regional data, and data comparable between the two sides of the Dutch-German border. The necessity to cooperate multidisciplinary and across borders is required to prevent a post-antibiotic era – in which common infections and minor injuries may lead to death.

Volledige artikel in Antimicrobial Resistance & Infection Control (ARIC), klik hier

Auteurs: Jan Müller1, Andreas Voss2 , Robin Köck3, Bhanu Sinha1, John W Rossen1, Martin Kaase4, Martin Mielke5, Inka Daniels-Haardt6, Annette Jurke7, Ron Hendrix1, Jan A Kluytmans8, Marjolein F Kluytmans-van den Bergh9, Matthias Pulz10, Jörg Herrmann11, Winfried V Kern12, Constanze Wendt13 and Alex W Friedrich1

Affliaties: 
1Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, hpc EB80, Groningen, 9713, GZ, The Netherlands
2Department of Medical Microbiology, Canisius-Wilhelmina Hospital and Radboud University Medical Center, Nijmegen, The Netherlands
3Institute of Hygiene, University Hospital Münster, Münster, Germany
4National Reference Laboratory for Multidrug Resistant Gram-negative Bacteria, Department of Medical Microbiology, Ruhr University Bochum, Bochum, Germany
5Robert Koch-Institute, Berlin, Germany
6Division of Health Protection, Health Promotion, NRW Centre for Health, Münster, Germany
7Department of Infectiology and Hygiene, NRW Centre for Health, Münster, Germany
8Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands
9Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, The Netherlands
10Governmental Institute of Public Health of Lower Saxony, Hannover, Germany
11Institute for Hygiene, University Hospital Oldenburg, Oldenburg, Germany
12Center for Infectious Diseases and Travel Medicine, University Hospital Freiburg, Freiburg, Germany
13Hygiene-Institute, University of Heidelberg, Heidelberg, Germany

 

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