gms | German Medical Science

Healthcare-associated infections (HAIs) are a leading cause of morbidity and mortality worldwide. Therapy is becoming ever more difficult due to the increasing rate of antimicrobial resistance among common HAI pathogens. Over the last decade, multi-drug-resistant (MDR) bacteria have been implicated in severe invasive infections and their occurrence has increased steadily. In 2012, the EARS-Net, including 29 European countries, reported a general European-wide increase of antimicrobial resistance in the Gram-negative pathogens under surveillance. The proportion of reported E. coli isolates resistant to third-generation cephalosporins ranged from 3% to 36%. Trends of carbapenem resistance showed a significant increase between 2008 and 2011 in different Euroepan countries. In 2012, 22.3% of all K. pneumoniae invasive isolates were resistant to at least three antimicrobial classes. Remarkably, also patients are starting to see the rate of HAI and antibiotic resistance as an important indicator of quality of care. The ESCMID evidence-based guidelines have been produced after a systematic review of published studies on infection prevention and control (IPC) interventions aimed at reducing the transmission of MDR-GNB. The recommendations are stratified by type of IPC intervention and species of MDR-GNB and are presented in the form of “basic” practices, recommended for all acute care facilities, and “additional special approaches” to be considered when there is still clinical and/or epidemiological and/or molecular evidence of ongoing transmission, despite the application of the basic measures. The level of evidence for and strength of each recommendation, were defined according to the GRADE approach. Comparison with national recommendations are needed to streamline and understand differences. Major grey areas need to be urgently addressed in order to reduce the burden of MDR-GN infections in hospitalised patients.