title: Highly resistant gram-negative microorganisms: incidence density and occurrence of nosocomial transmission (TRIANGLe Study).
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Medical Microbiology and Infection Control, Amphia Hospital, Breda, The Netherlands. ina.willemsen@gmail.com
authors: I
authors: I
authors: Willemsen
authors: S
authors: S
authors: Elberts
authors: C
authors: C
authors: Verhulst
authors: M
authors: M
authors: Rijnsburger
authors: M
authors: M
authors: Filius
authors: P
authors: P
authors: Savelkoul
authors: J
authors: J
authors: Kluytmans
authors: E
authors: E
authors: Lommerse
authors: L
authors: L
authors: Spanjaard
authors: B
authors: B
authors: Vlaminckx
authors: A
authors: A
authors: Vos
authors: M
authors: M
authors: Wulf
authors: M
authors: M
authors: Vos
authors: R
authors: R
authors: Wintermans
authors: G
authors: G
authors: Andriesse
authors: J
authors: J
authors: van Zeijl
authors: E
authors: E
authors: van der Vorm
authors: A
authors: A
authors: Buiting
authors: P
authors: P
authors: Sturm
authors: H
authors: H
authors: Blok
authors: A
authors: A
authors: Troelstra
authors: A
authors: A
authors: Kaiser
authors: C
authors: C
authors: Vandenbroucke-Grauls
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D024901:Drug Resistance, Multiple, Bacterial; D016946:Gram-Negative Aerobic Rods and Cocci / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D006092:Gram-Negative Facultatively Anaerobic Rods / Q000302:isolation & purification; D006769:Hospitals, General / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000592:standards; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies
chemical_list: D000900:Anti-Bacterial Agents