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Highly Resistant Gram-Negative Microorganisms Incidence Density and Occurrence of Nosocomial Transmission (TRIANGLe Study)

Part of: BARRY FARR AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

I. Willemsen ,
S. Elberts ,
C. Verhulst ,
M. Rijnsburger ,
M. Filius ,
P. Savelkoul ,
J. Kluytmans ,
E. Lommerse ,
L. Spanjaard  and
B. Vlaminckx
...Show all authors
I. Willemsen*
Affiliation:
Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
S. Elberts
Affiliation:
Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
C. Verhulst
Affiliation:
Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
M. Rijnsburger
Affiliation:
Department of Medical Microbiology and Infection Control, VUmc (Vrije Universiteit Medisch Centrum)University Medical Center, Amsterdam, the Netherlands
M. Filius
Affiliation:
SWAB (Stichting Werkgrope Antibioticabeleid) Working Group on the Use of Antimicrobial Agents, Academic Medical Center, Afdeling Infectieziekten, Tropische Geneeskunde en AIDS, Amsterdam, the Netherlands
P. Savelkoul
Affiliation:
Department of Medical Microbiology and Infection Control, VUmc (Vrije Universiteit Medisch Centrum)University Medical Center, Amsterdam, the Netherlands
J. Kluytmans
Affiliation:
Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands Department of Medical Microbiology and Infection Control, VUmc (Vrije Universiteit Medisch Centrum)University Medical Center, Amsterdam, the Netherlands
E. Lommerse
Affiliation:
Department of Infection Control, Academic Medical Center, Amsterdam, the Netherlands
L. Spanjaard
Affiliation:
Department of Infection Control, Academic Medical Center, Amsterdam, the Netherlands
B. Vlaminckx
Affiliation:
Laboratory for Microbiology and Infection Control, Antonius Hospital, Nieuwegein, the Netherlands
A. Vos
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
M. Wulf
Affiliation:
Department of Infection Control, Catharina Hospital, Eindhoven, the Netherlands
M. Vos
Affiliation:
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
R. Wintermans
Affiliation:
Laboratory for Microbiology and Infection Control, Roosendaal, the Netherlands
G. Andriesse
Affiliation:
Laboratory for Microbiology and Infection Control, Bergen op Zoom, the Netherlands
J. van Zeijl
Affiliation:
Department of Infection Control, Medical Center Leeuwarden, Leeuwarden, the Netherlands
E. van der Vorm
Affiliation:
Laboratory for Microbiology and Infection Control, Reinier de Graaf Groep, Delft, the Netherlands
A. Buiting
Affiliation:
Department of Infection Control, Sint Elisabeth Hospital, Tilburg, the Netherlands
P. Sturm
Affiliation:
Department of Medical Microbiology and Infectious Diseases, University Medical Center Nijmegen, Nijmegen, the Netherlands
H. Blok
Affiliation:
Department of Medical Microbiology and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
A. Troelstra
Affiliation:
Department of Medical Microbiology and Infectious Diseases, University Medical Center Utrecht, Utrecht, the Netherlands
A. Kaiser
Affiliation:
Department of Medical Microbiology and Infection Control, VUmc (Vrije Universiteit Medisch Centrum)University Medical Center, Amsterdam, the Netherlands
C. Vandenbroucke-Grauls
Affiliation:
Department of Medical Microbiology and Infection Control, VUmc (Vrije Universiteit Medisch Centrum)University Medical Center, Amsterdam, the Netherlands
*
Consultant Infection Control, Department of Medical Microbiology and Infection Control, Amphia Hospital, PO Box 90158, 4800 RK Breda, the Netherlands (ina.willemsen@gmail.comoriwillemsen@amphia.nl)
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Abstract

Objectives.

The objectives of this study were to determine the incidence density and the occurrence of horizontal spread of highly resistant gram-negative rods (HR-GNRs) in Dutch hospitals. The factors that influence these outcome measures were also investigated.

Methods.

All patients with HR-GNRs, as determined by sample testing, who were hospitalized in 1 of 18 hospitals during a 6-month period (April through October 2007) were included in this study. For all available isolates, the species was identified, susceptibility was determined (including the presence of extended-spectrum β-lactamases [ESBLs]), and molecular typing was performed. On the basis of a combination of species identification, molecular typing, and epidemiological data, the occurrence of nosocomial transmission was determined.

Results.

The mean incidence density of patients with HR-GNRs was 55 per 100,000 patient-days (cumulative incidence, 39 per 10,000 patients admitted). A facility being a university hospital was a statistically significant (P = .03) independent determinant of a higher incidence of patients with HR-GNRs. The majority of HR-GNR isolates were ESBL producers. The adjusted transmission index—the ratio between secondary and primary cases—in the participating hospitals ranged from 0.0 to 0.2. The overall adjusted transmission index of HR-GNRs was 0.07. No determinants for a higher transmission index were identified.

Discussion.

The nosocomial transmission rate of HR-GNRs was relatively low in all hospitals where well-established transmission-based precautions were used. The incidence density of patients with HR-GNRs was higher in university hospitals, probably due to the patient population and the complexity of the care provided.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 4 , April 2011 , pp. 333 - 341
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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