MRSA control strategies in Europekeeping up with epidemiology?

Transcription

1 MRSA 15 years in Belgium MRSA control strategies in Europekeeping up with epidemiology? Marc J. Struelens, MD, PhD Senior Expert, Scientific Advice Unit European Centre for Disease Prevention and Control, Stockholm, Sweden

2 MRSA: Is Europe winning the fight? How big a problem in Europe? Is the epidemiology changing? What are the national prevention strategies? Are they successful? What are the next steps?

3 Burden of Disease Caused by MRSA in EU, Iceland and Norway Annual estimate: Number of HAI caused by MRSA Number of deaths Number of extra hospital days attributable extra in-hospital costs of EUR 380 million for EU healthcare systems. ECDC/EMEA Joint Report The bacterial challenge: time to react

4 Diversification of MRSA epidemiology MSSA Patients in contact with livestock animals (LA-MRSA) Emerging clones Healthcare associated MRSA (HA-MRSA) MRSA in the community Patient with risk factors (HCA-MRSA) Patient without risk factors (CA-MRSA) Source: M.Hallin, Adapted from Witte, Clin Microbiol Infect 2009

5 Geographical clustering of MRSA spa types from hospitalized patients in Europe Grundmann (2010) PLoS Med 7(1): e

6 Regional emergence of MRSA ST5 subclones worldwide (SNP analysis) Nübel PNAS 2008:105:14130

7 Multiple acquisitions of SCCmec by MRSA ST5 subclones Nübel PNAS 2008;105:14130

8 Prevalence and Genotype of MRSA in Pig Production Farms EU, Norway and Switzerland Source: EFSA Journal 2009;7(11):1376

9 Emergence of Livestock-Associated MRSA ST398 in Humans, Europe 2008 MRSA-ST398 (% typed MRSA isolates) NL DK BE 0 50, , , ,000 Pig density x hum an population density index Van Cleef Emerging Infect Dis 2011: in press

10 MRSA % S.aureus Bacteremia, <1% 1 5% 5 10% 10 25% 25 50% >50% No data/low number Other countries Country with: Significant increase ( ) Significant decrease ( ) EARSS & Struelens Infect Control Hosp Epidemiol. 2010;31 S1:S42-

11 Population-weighted average proportion of resistant isolates (%) Population-Weighted Average % Resistant Isolates from Bloodstream Infections, EU, Iceland and Norway, ram-egative bacteria MRSA Mean decrease: 13% / 6 years 0 Methicillin-resistant S. aureus (MRSA) Vancomycin-resistant E. faecium Penicillin-resistant S. pneumoniae Courtesy : D.Monnet Source: EARSS & ECDC, In:

12 Trends from National MRSA Surveillance, Country reporting: Significant decrease Significant increase Stable or fluctuating Source: R.Köck Survey of National Focal Points for Antimicrobial Resistance, 2009

13 What are the key elements of success against MRSA in your country? Hand hygiene Active surveillance Isolation & C.Precautions Decolonisation Antimicrobial stewardship Courtesy R.Köck Source: Survey of National Focal Points for Antimicrobial Resistance, 2009

14 Hand Hygiene Campaigns in European Countries, WHO First Patient Safety Challenge & Hand Hygiene Day on May 5 Survey of hand hygiene campaigns in 30 countries (EU & candidate countries) 13 countries: national campaigns 10 countries: regional campaigns 3 countries: organizing campaigns Source: Magiorakos AP, et al. Euro Surveill 2009;14(17)

15 Alcohol Handrub & Isolation Policies Predict Lower Hospital MRSA Rates Linear regression modelling of infection & MRSA control policies in 169 European hospitals in 2001 Adjusted for antibiotic consumption, case-mix, hospital size and teaching status Factor Alcohol-based hand hygiene Single room isolation Problem for isolation MRSA rate difference - 17% (p<0.001) - 11 % (p=0.004) + 12% (p<0.001) MacKenzie Clin Microbiol Infect 2007;13:269

16 National Interventions for MRSA, England & Wales ( ) Source: S. Stone

17 MRSA Trends, England Reduction: 57 % Source: Health Protection Agency

18 MRSA Interventions in Acute Care, France Sources: V. Jarlier (Pers. Com) Carlet ICHE 2009;30:737

19 % de SARM parmi les S.aureus incidence pour 100 admis ou 1000 jours % MRSA in S.aureus and MRSA incidence Univ. Hospitals of Paris (n=39), Global decrease : 53 % ,4 0, % MRSA in S.aureus % de SARM incidence pour 100 admissions Rate per 100 admissions incidence pour 1000 JH CS Rate per Pt-Days 0, année Jarlier Arch Int Med 2010;170:552-9

20 Is Europe winning the fight against MRSA? in acute care settings Sustained prevention or reduction of endemic MRSA National control strategies: combined structural, horizontal & vertical interventions System change & political commitment Hand hygiene promotion MRSA screening & contact precautions Prudent antibiotic use Struelens Infect Control Hosp Epidemiol. 2010;31 S1:S42-4

21 MRSA Trends, Sweden Total Cases/yr Origin of MRSA Source: Struwe & Olson-Liljequist SWEDRES 2008

22 No. of isolates MRSA Trends, Denmark Import Hosp acq Com onset Hosp ass Com associated Large hospital outbreak New national guidelines Source: R.Skov, SSI

23 MRSA control in Europe: The next steps Analysis of national MRSA guidelines & evaluation of public health interventions Acute care: study effectiveness of rapid patient screening universal surveillance decolonization Primary & chronic care: develop surveillance and control Cross-border & cross-sector health care cooperation Harmonisation and strengthening of surveillance methods, including molecular typing Köck et al Euro Surveill. 2010;15(41):19688

24 MRSA control challenges & ECDC support Topic ECDC projects Year Healthcare Systematic review and evidence based guidance on MRSA control in healthcare facilities 2011 Community Systematic review and evidence based guidance on MRSA control in primary care 2011 EU coordination Review of national MRSA guidance Review of national MRSA surveillance system Harmonisation of MRSA molecular typing EPIS information exchange platform Köck et al Euro Surveill. 2010;15(41):19688.

25 Enhanced surveillance of MDR bacterial pathogens at EU level Harmonisation of typing methods for MDR bacteria surveillance Disseminate best laboratory practice & external quality assessment Coordinate genotypic data exchange & bio-informatics platform Markers of virulent/epidemic MDR clones or plasmids ECDC & ref labs (MRSA, C.difficile) ECDC & ref labs (MRSA, C.difficile) ECDC & ref labs EC Framework Pr. (TROCAR,MOSAR PILGRIM) ARPAC Recommendations CMI 2005;11:938

26 Thank you! R Köck, A Friedrich, D Monnet, B Jans, R Skov, V Jarlier, S Stone ECDC National Antimicrobial Resistance Focal Points JM Azanowsky, M Borg, G Bosevska, J Campos, I Codita, N Cöplu, B Catry, AC Costa, U Dumpis, P Esltrom, H Giamarellou, I Gysens, E Heisbourg, W Hryniewicz, S Kaljenic, T Kantardjiev, T Lejko Zupanc, M Mielke, H Mittermayer, I Muzlovic, A Pantosti, L Raka, J Reilly, J Struwe, S Thomas, S Wellsteed, H Zemlickova