Since March 2022, there has been an increase in the number of multi-resistant bacteria in the Netherlands, namely among patients from Ukraine. This emerged from a study by researchers from RIVM, among others.
The Netherlands normally has a relatively low prevalence of infections due to highly resistant microorganisms (HRMO) such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing Enterobacteriaceae (CPE), carbapenemase-producing Pseudomonas aeruginosa (CPPA) en carbapene-resistant Acinetobacter baumannii complex (CRAB). Over the years it has been found that a recent stay in a foreign hospital is a risk factor. That is why active screening takes place among hospital patients who have recently been admitted to a foreign hospital or stayed in an asylum seekers’ centre. Since March 2022, this also includes a large number of hospital patients from Ukraine.
Big increase
In the period from March 1 to August 31, 2022, BRMO was found in 58 patients from Ukraine during this screening. MRSA was diagnosed in 13 patients, CPE in 47, CPPA in 12 and CRAB in 3. Two, three or four different resistant microorganisms were found in 11 of the 58 patients. For MRSA this is a relatively small number, compared to the total number of MRSA isolates submitted to RIVM in the period 1 March to 31 August 2022 (1.2%), but for CPE and CPPA this was a relatively large share of the total number of submitted isolates (21 and 52%).
Measures
The researchers also examined the genetic material of the resistant microorganisms found. This showed, among other things, that there are no indications to date that MRSA and CPPA bacteria had been transferred from Ukrainian patients to Dutch patients. There are indications for transmission of CPE from Ukrainian patients to Dutch patients, but this has been rare so far. This could not be investigated for micro-organisms other than MRSA, CPE, CPPA and CRAB. Apparently the preventive measures taken are working sufficiently. The researchers do urge us to remain alert to HRMO and to continue to take adequate measures to prevent the spread.
Bron:
Zwittink RD, Wielders CC, Notermans DW, et al. Multidrug-resistant organisms in patients from Ukraine in the Netherlands, March to August 2022. Euro Surveill. 2022;27:2200896.
Comment Dr. Antoni Hendrickx, molecular microbiologist at RIVM and co-author of the publication
“The treatment of highly resistant micro-organisms, or BRMO, is complicated. That is why it is important to keep a close eye on its spread. In the Netherlands we do this with the national BRMO surveillance. As coordinator, I am jointly responsible for this. Samples of patient material are sent to us from about 50 different labs, spread throughout the Netherlands, in the event of a BRMO infection or carrier status. We then perform genotypic and phenotypic determinations in the laboratory and analyze all data to identify and report trends in resistance.”
“In the spring of 2022, alarm bells started ringing when a medical microbiologist discussed a case of a patient from Ukraine with a BRMO infection. That was shortly after the start of the conflict. Not long after, our national surveillance did indeed send us the first BRMO isolates of individuals, mostly patients from Ukraine. For us, this was a new situation that we had not seen before in a conflict situation. This probably has to do with the fact that there are more medical refugees in this conflict, who move from hospital to hospital.”
“Our research showed that there was a clear increase in the number of Ukrainian patients with BRMO. That in itself was not unexpected. It is known that multidrug-resistant bacteria such as CPE are relatively common in Eastern European and Mediterranean countries. What is most concerning is that these bacteria have so-called New Delhi metallo-β-lactamase (NDM) genes that can provide high levels of resistance. This makes treatment of an infection very complex.
Fortunately, we saw that hardly any multi-resistant bacteria were transferred from Ukrainian patients to other patients. That only happened sporadically. I think that is a compliment to the Dutch healthcare institutions and infection prevention experts. They have a good policy in this regard, which means they contribute to preventing the further spread of HRMO.”“I think this research shows that we in the Netherlands can properly monitor current trends in BRMO with national surveillance, and are able to report this quickly and adequately. For this we use, among other things, updated sequencing techniques, such as long-read and short-read sequencing. In the coming years, we will continue to improve the national surveillance system in order to be as well prepared as possible for new introductions and elevations of BRMO. Naturally, national surveillance cannot be carried out without the cooperation of the submitting laboratories, namely submitting BRMO isolates and sharing epidemiological information, so we are very grateful for that.”