title: National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: a 9 year experience.
abstract: BACKGROUND
  In the mid-1990s, the prevalence rate of multidrug-resistant bacteria (MDRB) in French hospitals was high and control of MDRB spread then became a major priority in the national infection control programme (ICP).
  
  
  METHODS
  To evaluate the impact of the ICP, a national coordination of MDRB surveillance was set up in 2002. Data were collected 3 months a year in healthcare facilities (HCFs) on a voluntary basis. All clinical specimens of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) were prospectively included. Incidences per 1000 patient days (PDs) were calculated and trends in incidence from 2003 to 2010 were assessed.
  
  
  RESULTS
  Participation in the surveillance increased from 478 HCFs in 2002 to 933 in 2010. In 2010, MRSA incidence was 0.40/1000 PDs: 1.14 in intensive care units (ICUs), 0.48 in acute care facilities (ACFs) and 0.27 in rehabilitation and long-term care facilities (RLTCFs). ESBLE incidence was 0.39/1000 PDs: 1.63 in ICUs, 0.46 in ACFs and 0.23 in RLTCFs. MRSA incidence significantly decreased from 0.72/1000 PDs in 2003 to 0.41/1000 PDs in 2010 (P<10(-3)); in contrast, ESBLE incidence significantly increased from 0.17/1000 PDs to 0.48/1000 PDs (P<10(-3)). The most prevalent ESBLE were Enterobacter aerogenes (34%) and Escherichia coli (25%) in 2003 and E. coli (60%) and Klebsiella pneumoniae (18%) in 2010.
  
  
  CONCLUSIONS
  These results demonstrate the positive impact of the national ICP on MRSA rates. In contrast, ESBLE incidence, especially ESBL-producing E. coli, is increasing dramatically and represents a serious threat for hospitals and for the community that deserves specific control actions.
authors.affiliation: CCLIN Paris Nord, rue Didot, 75014 Paris, France. anne.carbonne@egp.aphp.fr
authors.forename: Anne
authors.initials: A
authors.lastname: Carbonne
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnaud
authors.forename: Sylvie
authors.initials: S
authors.lastname: Maugat
authors.forename: Nicole
authors.initials: N
authors.lastname: Marty
authors.forename: Catherine
authors.initials: C
authors.lastname: Dumartin
authors.forename: Xavier
authors.initials: X
authors.lastname: Bertrand
authors.forename: Odile
authors.initials: O
authors.lastname: Bajolet
authors.forename: Anne
authors.initials: A
authors.lastname: Savey
authors.forename: Thierry
authors.initials: T
authors.lastname: Fosse
authors.forename: Mathieu
authors.initials: M
authors.lastname: Eveillard
authors.forename: Hélène
authors.initials: H
authors.lastname: Sénéchal
authors.forename: Bruno
authors.initials: B
authors.lastname: Coignard
authors.forename: Pascal
authors.initials: P
authors.lastname: Astagneau
authors.forename: Vincent
authors.initials: V
authors.lastname: Jarlier
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology*; D005602:France; D006761:Hospitals; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases