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Published in: BMC Infectious Diseases 1/2015

Open Access 01-12-2015 | Research article

Influx of multidrug-resistant organisms by country-to-country transfer of patients

Authors: Nico T. Mutters, Frank Günther, Anja Sander, Alexander Mischnik, Uwe Frank

Published in: BMC Infectious Diseases | Issue 1/2015

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Abstract

Background

Multidrug-resistant organisms (MDRO) are a worldwide problem. International migration and travel facilitate the spread of MDRO. Therefore the goal of our study was to assess the risk of influx of MDRO from patients transferred to one of Central Europe’s largest hospitals from abroad.

Methods

A mono-centre study was conducted. All patients transferred from other countries were screened; additional data was collected on comorbidities, etc. Presence of carbapenemases of multidrug-resistant Gram-negatives was confirmed by PCR. The association between length of stay, being colonized and/or infected by a MDRO, country of origin, diagnosis and other factors was assessed by binomial regression analyses.

Results

From 2012 to 2013, one fifth of all patients were colonized with MDRO (Methicillin-resistant Staphylococcus aureus [4.1 %], Vancomycin-resistant Enterococci [2.9 %], multidrug-resistant Gram-negatives [12.8 %] and extensively drug-resistant Gram-negatives [3.4 %]). The Gram-negatives carried a variety of carbapenemases including OXA, VIM, KPC and NDM. The length of stay was significantly prolonged by 77.2 % in patients colonized with a MDRO, compared to those not colonized (p<0.0001).

Conclusions

Country-to-Country transfer of patients to European hospitals represents a high risk of introduction of MDRO and infection control specialists should endorse containment and screening measures.
Literature
1.
go back to reference Centers-for-Disease-Control-and-Prevention: Antibiotic Resistance Threats in the United States. Edited by CDC: CDC; 2013: 1–114. Centers-for-Disease-Control-and-Prevention: Antibiotic Resistance Threats in the United States. Edited by CDC: CDC; 2013: 1–114.
2.
go back to reference Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection. Clin Infect Dis. 2011;53(1):49–56.CrossRefPubMed Rogers BA, Aminzadeh Z, Hayashi Y, Paterson DL. Country-to-country transfer of patients and the risk of multi-resistant bacterial infection. Clin Infect Dis. 2011;53(1):49–56.CrossRefPubMed
3.
go back to reference Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010;15(41):19688.PubMed Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, et al. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. Euro Surveill. 2010;15(41):19688.PubMed
4.
go back to reference Johnson AP. Methicillin-resistant Staphylococcus aureus: the European landscape. J Antimicrob Chemother. 2011;66 Suppl 4:iv43–8.PubMed Johnson AP. Methicillin-resistant Staphylococcus aureus: the European landscape. J Antimicrob Chemother. 2011;66 Suppl 4:iv43–8.PubMed
5.
go back to reference Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis. 2001;32 Suppl 2:S114–132.CrossRefPubMed Diekema DJ, Pfaller MA, Schmitz FJ, Smayevsky J, Bell J, Jones RN, et al. Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997–1999. Clin Infect Dis. 2001;32 Suppl 2:S114–132.CrossRefPubMed
6.
go back to reference Molton JS, Tambyah PA, Ang BS, Ling ML, Fisher DA. The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia. Clin Infect Dis. 2013;56(9):1310–8.CrossRefPubMed Molton JS, Tambyah PA, Ang BS, Ling ML, Fisher DA. The global spread of healthcare-associated multidrug-resistant bacteria: a perspective from Asia. Clin Infect Dis. 2013;56(9):1310–8.CrossRefPubMed
7.
go back to reference Mutters NT, Brooke RJ, Frank U, Heeg K. Low risk of apparent transmission of vancomycin-resistant Enterococci from bacteraemic patients to hospitalized contacts. Am J Infect Control. 2013;41(9):778–81.CrossRefPubMed Mutters NT, Brooke RJ, Frank U, Heeg K. Low risk of apparent transmission of vancomycin-resistant Enterococci from bacteraemic patients to hospitalized contacts. Am J Infect Control. 2013;41(9):778–81.CrossRefPubMed
8.
go back to reference Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29(11):996–1011.CrossRefPubMed Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol. 2008;29(11):996–1011.CrossRefPubMed
9.
go back to reference Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 2008;13(47):1–11. Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 2008;13(47):1–11.
10.
go back to reference Nordmann P, Dortet L, Poirel L. Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends in molecular medicine. 2012;18(5):263–72.CrossRefPubMed Nordmann P, Dortet L, Poirel L. Carbapenem resistance in Enterobacteriaceae: here is the storm! Trends in molecular medicine. 2012;18(5):263–72.CrossRefPubMed
11.
go back to reference Rolain JM, Parola P, Cornaglia G. New Delhi metallo-beta-lactamase (NDM-1): towards a new pandemia? Clin Microbiol Infect. 2010;16(12):1699–701.CrossRefPubMed Rolain JM, Parola P, Cornaglia G. New Delhi metallo-beta-lactamase (NDM-1): towards a new pandemia? Clin Microbiol Infect. 2010;16(12):1699–701.CrossRefPubMed
12.
go back to reference Drew RJ, Turton JF, Hill RL, Livermore DM, Woodford N, Paulus S, et al. Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital. J Hosp Infect. 2013;84(4):300–4.CrossRefPubMed Drew RJ, Turton JF, Hill RL, Livermore DM, Woodford N, Paulus S, et al. Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital. J Hosp Infect. 2013;84(4):300–4.CrossRefPubMed
13.
go back to reference Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20(9):821–30.CrossRefPubMed Nordmann P, Poirel L. The difficult-to-control spread of carbapenemase producers among Enterobacteriaceae worldwide. Clin Microbiol Infect. 2014;20(9):821–30.CrossRefPubMed
14.
go back to reference Eigner U, Holfelder M, Oberdorfer K, Betz-Wild U, Bertsch D, Fahr AM. Performance of a matrix-assisted laser desorption ionization-time-of-flight mass spectrometry system for the identification of bacterial isolates in the clinical routine laboratory. Clin Lab. 2009;55(7–8):289–96.PubMed Eigner U, Holfelder M, Oberdorfer K, Betz-Wild U, Bertsch D, Fahr AM. Performance of a matrix-assisted laser desorption ionization-time-of-flight mass spectrometry system for the identification of bacterial isolates in the clinical routine laboratory. Clin Lab. 2009;55(7–8):289–96.PubMed
15.
go back to reference Hofko M, Mischnik A, Kaase M, Zimmermann S, Dalpke AH. Detection of carbapenemases by real-time PCR and melt curve analysis on the BD Max system. J Clin Microbiol. 2014;52(5):1701–4.CrossRefPubMedPubMedCentral Hofko M, Mischnik A, Kaase M, Zimmermann S, Dalpke AH. Detection of carbapenemases by real-time PCR and melt curve analysis on the BD Max system. J Clin Microbiol. 2014;52(5):1701–4.CrossRefPubMedPubMedCentral
16.
go back to reference Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2011;18(3):268–81.CrossRefPubMed Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2011;18(3):268–81.CrossRefPubMed
17.
go back to reference Harmsen D, Claus H, Witte W, Rothganger J, Claus H, Turnwald D, et al. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41(12):5442–8.CrossRefPubMedPubMedCentral Harmsen D, Claus H, Witte W, Rothganger J, Claus H, Turnwald D, et al. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol. 2003;41(12):5442–8.CrossRefPubMedPubMedCentral
18.
go back to reference Wendt C, Schutt S, Dalpke AH, Konrad M, Mieth M, Trierweiler-Hauke B, et al. First outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany. Eur J Clin Microbiol Infect Dis. 2010;29(5):563–70.CrossRefPubMed Wendt C, Schutt S, Dalpke AH, Konrad M, Mieth M, Trierweiler-Hauke B, et al. First outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in Germany. Eur J Clin Microbiol Infect Dis. 2010;29(5):563–70.CrossRefPubMed
19.
go back to reference Moro M, Nizzero P, Biancardi A, Baldan R, Scarpellini P, Curti C, et al. An outbreak caused by multidrug-resistant OXA-58-positive Acinetobacter baumannii in an intensive care unit in Italy. J Hosp Infect. 2008;68(1):97–9.CrossRefPubMed Moro M, Nizzero P, Biancardi A, Baldan R, Scarpellini P, Curti C, et al. An outbreak caused by multidrug-resistant OXA-58-positive Acinetobacter baumannii in an intensive care unit in Italy. J Hosp Infect. 2008;68(1):97–9.CrossRefPubMed
20.
go back to reference Ben-David D, Kordevani R, Keller N, Tal I, Marzel A, Gal-Mor O, et al. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect. 2012;18(1):54–60.CrossRefPubMed Ben-David D, Kordevani R, Keller N, Tal I, Marzel A, Gal-Mor O, et al. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect. 2012;18(1):54–60.CrossRefPubMed
21.
go back to reference Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sanchez-Ortega I, et al. Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother. 2011;66(3):657–63.CrossRefPubMed Gudiol C, Tubau F, Calatayud L, Garcia-Vidal C, Cisnal M, Sanchez-Ortega I, et al. Bacteraemia due to multidrug-resistant Gram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother. 2011;66(3):657–63.CrossRefPubMed
22.
go back to reference Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29(12):1099–106.CrossRefPubMed Patel G, Huprikar S, Factor SH, Jenkins SG, Calfee DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol. 2008;29(12):1099–106.CrossRefPubMed
23.
go back to reference Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother. 2008;52(3):1028–33.CrossRefPubMed Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, Schwartz D, Leavitt A, Carmeli Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother. 2008;52(3):1028–33.CrossRefPubMed
24.
go back to reference Russell DL, Flood A, Zaroda TE, Acosta C, Riley MM, Busuttil RW, et al. Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant. 2008;8(8):1737–43.CrossRefPubMed Russell DL, Flood A, Zaroda TE, Acosta C, Riley MM, Busuttil RW, et al. Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant. 2008;8(8):1737–43.CrossRefPubMed
25.
go back to reference Niven DJ, Laupland KB, Gregson DB, Church DL, Group SaSI. Epidemiology of Staphylococcus aureus nasal colonization and influence on outcome in the critically ill. J Crit Care. 2009;24(4):583–9.CrossRefPubMed Niven DJ, Laupland KB, Gregson DB, Church DL, Group SaSI. Epidemiology of Staphylococcus aureus nasal colonization and influence on outcome in the critically ill. J Crit Care. 2009;24(4):583–9.CrossRefPubMed
26.
go back to reference Nemeth J, Ledergerber B, Preiswerk B, Nobile A, Karrer S, Ruef C, et al. Multidrug-resistant bacteria in travellers hospitalized abroad: prevalence, characteristics, and influence on clinical outcome. J Hosp Infect. 2012;82(4):254–9.CrossRefPubMed Nemeth J, Ledergerber B, Preiswerk B, Nobile A, Karrer S, Ruef C, et al. Multidrug-resistant bacteria in travellers hospitalized abroad: prevalence, characteristics, and influence on clinical outcome. J Hosp Infect. 2012;82(4):254–9.CrossRefPubMed
Metadata
Title
Influx of multidrug-resistant organisms by country-to-country transfer of patients
Authors
Nico T. Mutters
Frank Günther
Anja Sander
Alexander Mischnik
Uwe Frank
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2015
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-015-1173-8

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