The prevalence rate of MDRB in French hospitals is one of the highest among European countries. Since the mid 90s, control of MDRB patient-to-patient transmission has been a main priority for the national infection control programme. In 1998, hospitals were advised to strengthen MDRB surveillance and prevention based on defined national guidelines.
To assess the impact of this program
A national coordination of MDRB surveillance networks was set up in 2002: data were collected three months a year from volunteer healthcare facilities. All diagnosis specimens (a strain with the same antibiotype per patient) of methicillin-resistant S. aureus (MRSA), and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) were prospectively included. The incidence rate per 1000 patient – days (pd) was estimated for MRSA and ESBLE. Trends in incidence from 2004 to 2008 were assessed using Poisson regression.
Results: The number of participating laboratories increased from 478 in 2002 to 930 in 2008 accounting for 58% of all French hospital beds. In 2008, MRSA incidence was the highest in intensive care unit (1.72 MRSA-patients per 1,000 pd), compared to 0.53 in acute care and 0.29 in long term care. ESBLE incidence was the highest in intensive care unit (1.35), compared to 0.34 in acute care and 0.15 in long term care. The most frequent ESBLE was Enterobacter aerogenes (36%) in 2002 and Escherichia coli (58%) in 2008. Bacteremia accounted, respectively, for 9% of MRSA and 8% of ESBLE cases. The incidence trends from 2004 to 2008 were analysed in a subset of 302 Health Care Facilities: MRSA incidence significantly decreased from 0.66 in 2004 to 0.51 per 1,000 pd in 2008. This decrease concerned all types of health care settings. However, ESBLE incidence significantly increased from 0.17 to 0.31 per 1,000 pd; this increase was not observed in long term care.
These results demonstrate the positive impact of the national IC program on hospital-acquired MRSA rates; however, the incidence remains high and efforts have to be sustained. In contrast, ESBLE incidence is increasing especially ESBL-producing Escherichia coli, which represents a threat not only for hospitals but also the community and would deserve a specific control program.