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. 2023 Dec 8;12(1):143.
doi: 10.1186/s13756-023-01350-9.

Description of a nationwide structure for monitoring nosocomial outbreaks of (highly resistant) microorganisms in the Netherlands: characteristics of outbreaks in 2012-2021

Sjoukje Hs Woudt  1 , Annelot F Schoffelen  2 , Florine Nj Frakking  2   3 , E Ascelijn Reuland  2   3   4 , Juliëtte A Severin  5 , Marije den Drijver  6 , Anja Haenen  2 , Marga Mg Nonneman  7 , Daan W Notermans  2   8 , Desiree Cm Aan de Stegge  9 , Sacha F de Stoppelaar  2   10 , Christina Mje Vandenbroucke-Grauls  8   11 , Sabine C de Greeff  2
Affiliations

Description of a nationwide structure for monitoring nosocomial outbreaks of (highly resistant) microorganisms in the Netherlands: characteristics of outbreaks in 2012-2021

Sjoukje Hs Woudt et al. Antimicrob Resist Infect Control. .

Abstract

Background: Before 2012, established national surveillance systems in the Netherlands were not able to provide a timely, comprehensive epidemiological view on nosocomial outbreaks. The Healthcare-associated Infections and AntiMicrobial Resistance Monitoring Group (SO-ZI/AMR) was initiated in 2012 for timely national nosocomial outbreak monitoring and risk assessment. This paper aims to describe the achievements of the SO-ZI/AMR by presenting characteristics of outbreaks reported in 2012-2021.

Methods: Hospitals and, since 2015, long-term care facilities (LTCF) were requested to report outbreaks when (1) continuity of care was threatened, or (2) transmission continued despite control measures. A multi-disciplinary expert panel (re-)assessed the public health risk of outbreaks during monthly meetings, using 5 severity phases and based on data collected via standardised questionnaires. We descriptively studied the panel's consensus-based severity classification, distribution of (highly resistant) microorganisms, and duration and size of outbreaks between April 2012 and December 2021.

Results: In total, 353 hospital outbreaks and 110 LTCF outbreaks were reported. Most outbreaks (hospitals: n = 309 (88%), LTCF: n = 103 (94%)) did not progress beyond phase 1 (no public health implications, outbreak expected to be controlled within two months), one hospital outbreak reached phase 4 (insufficient/ineffective response: possible public health threat, support offered). Highly resistant microorganisms (HRMO) were involved in 269 (76%) hospital and 103 (94%) LTCF outbreaks. Most outbreaks were caused by methicillin-resistant Staphylococcus aureus (MRSA; n = 93 (26%) in hospitals, n = 80 (72%) in LTCF), vancomycin-resistant Enterococcus faecium (VRE; n = 116 (33%) in hospitals, n = 2 (2%) in LTCF) and highly resistant Enterobacterales (n = 41 (12%) in hospitals, n = 20 (18%) in LTCF). Carbapenemase-producing gram-negative bacteria were involved in 32 (9.1%) hospital and five (4.5%) LTCF outbreaks. In hospitals, VRE outbreaks had the longest duration (median 2.3; range 0.0-22.8 months) and widest range of affected patients (median 9; range 2-483).

Conclusions: The SO-ZI/AMR provided national insight into the characteristics of nosocomial outbreaks over the past decade. HRMO outbreaks - mostly caused by MRSA, VRE (in hospitals) and highly resistant Enterobacterales - occurred regularly, but most of them were controlled quickly and did not develop into a public health threat. The SO-ZI/AMR has become a solid monitoring body, essential to assess risks and raise awareness of potential HRMO threats.

Keywords: Epidemiology; Infection control; Multidrug resistance; Nosocomial infections; Outbreaks; Surveillance.

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Conflict of interest statement

One of our co-authors, Christina MJE Vandenbroucke-Grauls, is an Editorial Board Member of Antimicrobial Resistance and Infection Control.Other than that, the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

Figures

Fig. 1
Fig. 1
Distribution of (highly resistant) microorganisms among outbreaks reported to the SO-ZI/AMR (2012-2021a), by healthcare setting and year. SO-ZI/AMR: Healthcare-associated Infection and AntiMicrobial Resistance Monitoring Group. a April 2012 – December 2021. *Clostridioides difficile, other Enterobacterales, methicillin-susceptible S. aureus, vancomycin-susceptible E. faecium, non-carbapenemase-producing Acinetobacter spp. / P. aeruginosa, viruses, other microorganisms
See this image and copyright information in PMC

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