PMID- 38066583 OWN - NLM STAT- MEDLINE DCOM- 20231216 LR - 20240222 IS - 2047-2994 (Electronic) IS - 2047-2994 (Linking) VI - 12 IP - 1 DP - 2023 Dec 8 TI - Description of a nationwide structure for monitoring nosocomial outbreaks of (highly resistant) microorganisms in the Netherlands: characteristics of outbreaks in 2012-2021. PG - 143 LID - 10.1186/s13756-023-01350-9 [doi] LID - 143 AB - BACKGROUND: Before 2012, established national surveillance systems in the Netherlands were not able to provide a timely, comprehensive epidemiological view on nosocomial outbreaks. The Healthcare-associated Infections and AntiMicrobial Resistance Monitoring Group (SO-ZI/AMR) was initiated in 2012 for timely national nosocomial outbreak monitoring and risk assessment. This paper aims to describe the achievements of the SO-ZI/AMR by presenting characteristics of outbreaks reported in 2012-2021. METHODS: Hospitals and, since 2015, long-term care facilities (LTCF) were requested to report outbreaks when (1) continuity of care was threatened, or (2) transmission continued despite control measures. A multi-disciplinary expert panel (re-)assessed the public health risk of outbreaks during monthly meetings, using 5 severity phases and based on data collected via standardised questionnaires. We descriptively studied the panel's consensus-based severity classification, distribution of (highly resistant) microorganisms, and duration and size of outbreaks between April 2012 and December 2021. RESULTS: In total, 353 hospital outbreaks and 110 LTCF outbreaks were reported. Most outbreaks (hospitals: n = 309 (88%), LTCF: n = 103 (94%)) did not progress beyond phase 1 (no public health implications, outbreak expected to be controlled within two months), one hospital outbreak reached phase 4 (insufficient/ineffective response: possible public health threat, support offered). Highly resistant microorganisms (HRMO) were involved in 269 (76%) hospital and 103 (94%) LTCF outbreaks. Most outbreaks were caused by methicillin-resistant Staphylococcus aureus (MRSA; n = 93 (26%) in hospitals, n = 80 (72%) in LTCF), vancomycin-resistant Enterococcus faecium (VRE; n = 116 (33%) in hospitals, n = 2 (2%) in LTCF) and highly resistant Enterobacterales (n = 41 (12%) in hospitals, n = 20 (18%) in LTCF). Carbapenemase-producing gram-negative bacteria were involved in 32 (9.1%) hospital and five (4.5%) LTCF outbreaks. In hospitals, VRE outbreaks had the longest duration (median 2.3; range 0.0-22.8 months) and widest range of affected patients (median 9; range 2-483). CONCLUSIONS: The SO-ZI/AMR provided national insight into the characteristics of nosocomial outbreaks over the past decade. HRMO outbreaks - mostly caused by MRSA, VRE (in hospitals) and highly resistant Enterobacterales - occurred regularly, but most of them were controlled quickly and did not develop into a public health threat. The SO-ZI/AMR has become a solid monitoring body, essential to assess risks and raise awareness of potential HRMO threats. CI - (c) 2023. The Author(s). FAU - Woudt, Sjoukje Hs AU - Woudt SH AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. sjoukje.woudt@rivm.nl. FAU - Schoffelen, Annelot F AU - Schoffelen AF AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. FAU - Frakking, Florine Nj AU - Frakking FN AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. AD - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands. FAU - Reuland, E Ascelijn AU - Reuland EA AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. AD - Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands. AD - Saltro Diagnostic Center for Primary Care, Utrecht, The Netherlands. FAU - Severin, Juliette A AU - Severin JA AD - Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands. FAU - den Drijver, Marije AU - den Drijver M AD - Department of Infection Control, Maasstad Hospital, Rotterdam, The Netherlands. FAU - Haenen, Anja AU - Haenen A AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. FAU - Nonneman, Marga Mg AU - Nonneman MM AD - TanteLouise, Bergen op Zoom, The Netherlands. FAU - Notermans, Daan W AU - Notermans DW AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. AD - Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, The Netherlands. FAU - Aan de Stegge, Desiree Cm AU - Aan de Stegge DC AD - Beweging 3.0, Amersfoort, The Netherlands. FAU - de Stoppelaar, Sacha F AU - de Stoppelaar SF AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. AD - Infectious diseases department, Amsterdam Academic Medical Center, Amsterdam, The Netherlands. FAU - Vandenbroucke-Grauls, Christina Mje AU - Vandenbroucke-Grauls CM AD - Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, The Netherlands. AD - Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark. FAU - de Greeff, Sabine C AU - de Greeff SC AD - Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20231208 PL - England TA - Antimicrob Resist Infect Control JT - Antimicrobial resistance and infection control JID - 101585411 SB - IM MH - Humans MH - *Cross Infection/prevention & control MH - *Methicillin-Resistant Staphylococcus aureus MH - Netherlands/epidemiology MH - Hospitals MH - Disease Outbreaks/prevention & control MH - Bacteria PMC - PMC10709896 OTO - NOTNLM OT - Epidemiology OT - Infection control OT - Multidrug resistance OT - Nosocomial infections OT - Outbreaks OT - Surveillance COIS- One of our co-authors, Christina MJE Vandenbroucke-Grauls, is an Editorial Board Member of Antimicrobial Resistance and Infection Control.Other than that, the authors have no competing interests as defined by BMC, or other interests that might be perceived to influence the results and/or discussion reported in this paper. EDAT- 2023/12/09 10:47 MHDA- 2023/12/17 09:43 PMCR- 2023/12/08 CRDT- 2023/12/09 00:11 PHST- 2023/07/28 00:00 [received] PHST- 2023/11/30 00:00 [accepted] PHST- 2023/12/17 09:43 [medline] PHST- 2023/12/09 10:47 [pubmed] PHST- 2023/12/09 00:11 [entrez] PHST- 2023/12/08 00:00 [pmc-release] AID - 10.1186/s13756-023-01350-9 [pii] AID - 1350 [pii] AID - 10.1186/s13756-023-01350-9 [doi] PST - epublish SO - Antimicrob Resist Infect Control. 2023 Dec 8;12(1):143. doi: 10.1186/s13756-023-01350-9.