MRSA verliest terrein: aanpak is voorbeeld in strijd tegen andere ziekenhuisbacterieën
Studies van het Wetenschappelijk Instituut Volksgezondheid (WIV-ISP) tonen aan dat de ziekenhuisbacterie MRSA stilaan terrein verliest dankzij de gezamenlijke aanpak van de betrokken instanties. Het WIV-ISP en de nationale referentielaboratoria voor resistente bacterien deden in 2011 onderzoek naar dragerschap van antibioticaresistente bacterien bij ouderen in 60 Belgische woonzorgcentra (WZC).
In vergelijking met de vorige studie in 2005, is dragerschap van de MRSA-ziekenhuisbacterie bij WZC-bewoners in Belgie met 7% gedaald. Ook de nationale surveillance van Methicilline-resistente Staphylococcus aureus (MRSA), uitgevoerd door het WIV-ISP in ziekenhuizen, toont dezelfde gunstige evolutie. Beide studies tonen daarentegen ook aan dat tegelijkertijd andere antibioticaresistente bacterien de kop opsteken. An integrated approach in both health centers and hospitals, but also outside, remains necessary.
The Scientific Institute of Public Health and the national reference laboratories for resistant bacteria (UCL, CHU Mont-Godinne in ULB, Erasmusziekenhuis) investigated in 2005 en 2011 in 60 Belgische woonzorgcentra (WZC) how many older people are carriers of antibiotic-resistant bacteria.
"A comparison of two studies show that during that period the carriage of Methicillin-resistant Staphylococcus aureus (called MRSA hospital bacteria) met 7% fallen at the homes and care ", Beatrice says Jans of the Scientific Institute of Public Health. "A similar favorable trend was also seen in the annual report 2011 national surveillance of MRSA in hospitals, since 1994 is performed by the WIV-ISP and the reference laboratory for staphylococci.
Since 2003 The number of patients that MRSA contracted during a stay in hospital fell by more than half. "Olivier Denis of MRSA reference laboratory (Erasmusziekenhuis ULB) adds: "In addition to this decrease in the number of infections with methicillin-resistant staphylococci, there are now fewer staphylococci resistant to other antibiotics'.
This favorable evolution is due to the efforts that Belgium has made in recent years to tackle MRSA in healthcare facilities and hospitals. Some examples are:
* So follow the reference laboratories and the WIV-ISP very closely the evolution of MRSA.
* The Belgian Commission for the Coordination of the Antibiotic Policy (BAPCOC) worked a rational antibiotic policy for all sectors to prevent further development of resistance. The effectiveness of this policy is evident from the studies in the nursing homes: between 2005 en 2011 the percentage dropped residents that had recently used an antibiotic with more than 10%.
* "At the same time also emphasized the importance of good hand hygiene. This were rolled out by the various governments in Belgium several campaigns for hospitals and WZC to MRSA transmission via the hands of healthcare staff, patients and visitors to prevent, "said Anne Simon of the Unite d'Hygiene Hospita Cavaliere, Cliniques Universitaires St Luc.
* The hospital hygiene teams and the WZC staff have developed a targeted infection control policy, with more and more systematic cooperation and communication between the two sectors. The latter is essential, as antibiotic resistance knows no borders.
"All these actions seem to be bearing fruit, but there are additional efforts, because while MRSA is driven back, stabbing new types of resistant bacteria are emerging "said Youri Glupczynski of the national reference laboratory for resistant enterobacteria (CHU Mont-Godinne UCL). "As a result of the improper use of antibiotics developed originally banal intestinal bacteria such as Escherichia coli and Klebsiella pneumoniae mechanisms that degrade antibiotics.
So make certain bacteria the enzyme `Extended Spectrum Beta-Lactamase (ESBL)' to, allowing treatment with beta-lactam antibiotics is difficult. Analog weakens the enzyme Carbapenemase (CPE) of werking will carbapenemantibiotica. As a result, the arsenal of antibiotics, which can still be used to treat such infections is much smaller and must seize physicians to increasingly heavy antibiotics, against which bacteria can develop resistance, in turn,. It is therefore essential to break this vicious circle by using antibiotics only when they are really needed, "explains Michiel Costers of the Belgian Commission for the Coordination of the Antibiotic Policy in.
"In principle, anyone can be a carrier of resistant intestinal bacteria. Healthy people usually notice nothing of it. Only in severely ill or severely weakened people such contamination can effectively lead to infection ", sets Beatrice Jans (WIV-ISP) from. The national study in WZC (2011) shows that the percentage of ESBL carriers (without outward clinical signs) in WZC is rather limited; ESBL was 6.2% of the residents found. The surveillance in hospitals shows that the number of resistant ESBL-producing bacteria increased between 2005 en 2011: the number of ESBL-producing E. coli increased from 4% naar 7,4%; the percentage of ESBL-producing Klebsiella increased from 6.9% naar 11.6%.
Also carbapenem-resistant bacteria are more prevalent in hospitals. This resistance was several years ago still rare in our country, but blew over through transfer patients from hospitals in North Africa, Southern Europe and Asia. During the first 6 months 2012 In total, 217 CPE cases identified in hospitals. "Meanwhile CPE is no longer exclusive to travelers, also, for example patients in residential care centers and in the community have to do with it ", clarifies Youri Glupczynski (CHU Mont-Godinne).
To the advance of these resistances as soon as possible to quell, the experience from the fight against MRSA is fully deployed at these new hospital bacteria. "So now set a national approach, with a targeted surveillance and specific guidelines of the Supreme Health Council to address CPE bacteria in healthcare facilities ", says Michiel Costers (BAPCOC).
The message for the future is therefore: remain vigilant, careful with antibiotics, and in particular promote hand hygiene. Not only in healthcare facilities, but also outside, everyone.
Bron: Nieuwsbank / Press Center