Influx of multidrug-resistant organisms by country-to-country transfer of patients.
BACKGROUND
Multidrug-resistant organisms (MDRO) are a worldwide problem. International migration and travel facilitate the spread of MDRO. Therefore the goal of our study was to assess the risk of influx of MDRO from patients transferred to one of Central Europe's largest hospitals from abroad.


METHODS
A mono-centre study was conducted. All patients transferred from other countries were screened; additional data was collected on comorbidities, etc. Presence of carbapenemases of multidrug-resistant Gram-negatives was confirmed by PCR. The association between length of stay, being colonized and/or infected by a MDRO, country of origin, diagnosis and other factors was assessed by binomial regression analyses.


RESULTS
From 2012 to 2013, one fifth of all patients were colonized with MDRO (Methicillin-resistant Staphylococcus aureus [4.1 %], Vancomycin-resistant Enterococci [2.9 %], multidrug-resistant Gram-negatives [12.8 %] and extensively drug-resistant Gram-negatives [3.4 %]). The Gram-negatives carried a variety of carbapenemases including OXA, VIM, KPC and NDM. The length of stay was significantly prolonged by 77.2 % in patients colonized with a MDRO, compared to those not colonized (p<0.0001).


CONCLUSIONS
Country-to-Country transfer of patients to European hospitals represents a high risk of introduction of MDRO and infection control specialists should endorse containment and screening measures.
Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany. Nico.Mutters@med.uni-heidelberg.de.|German Center for Infection Research, Heidelberg University Hospital, Heidelberg, Germany. Nico.Mutters@med.uni-heidelberg.de.
Nico T
NT
Mutters
Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany. Frank.guenther@med.uni-heidelberg.de.
Frank
F
Günther
Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany. sander@imbi.uni-heidelberg.de.
Anja
A
Sander
Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany. alexander.mischnik@uniklinik-freiburg.de.|German Center for Infection Research, Heidelberg University Hospital, Heidelberg, Germany. alexander.mischnik@uniklinik-freiburg.de.
Alexander
A
Mischnik
Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany. Uwe.Frank@med.uni-heidelberg.de.
Uwe
U
Frank
D000328:Adult; D001426:Bacterial Proteins / Q000378:metabolism; D024901:Drug Resistance, Multiple, Bacterial; D005060:Europe; D005260:Female; D006090:Gram-Negative Bacteria / Q000201:enzymology / Q000302:isolation & purification* / Q000378:metabolism; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D012044:Regression Analysis; D012306:Risk; D065507:Vancomycin-Resistant Enterococci / Q000302:isolation & purification; D001618:beta-Lactamases / Q000378:metabolism
D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase