In short
Infections as a result of multi-drug-resistant organisms (MDROs) constitute a major health problem worldwide. MDROs are bacteria that are resistant to most antibiotics. Research into the carriage of resistant germs is important not only in hospitals, but also in nursing homes (NHs). After all, these institutions are home to elderly, vulnerable residents and carriage still often goes undetected. People, who are carriers of a resistant germ, do not show any symptoms of a disease and can sometimes get over the bacteria themselves. However, when the bacteria causes an infection and a person becomes sick, this is often hard to treat, because some antibiotics no longer work.
Project description
Sciensano is organising for the fourth time (results 2005, 2011, 2015) a study on the prevalence of the carriage of MDROs in Belgian nursing home residents on one random day (prevalence). The last prevalence study was conducted in 2015. The study will be carried out again in Fall 2024, in collaboration with the national reference centres (NRCs). The carriage of MRSA*, ESBL-E**, CPE*** and VRE**** are studied and compared with the results from previous MDRO studies so that we can chart the evolution.
In total, Sciensano will select 1,530 nursing home residents from a sample of 30 Belgian NHs (51 residents per institution). Samples are taken from these residents on the same day. To detect MRSA carriers, we take a swab from the throat, nose and perineum (the area between the genitals and the anus). To detect ESBL-E, CPE and VRE we take a rectal swab. This treatment is carried out by the institution’s nursing or care staff to keep the impact on residents as low as possible.
In addition to taking swabs, we ask for every resident included in the study, to fill in a questionnaire. In this, we ask about the resident’s general characteristics, risk factors, use of antibiotics and previous history of carrying MDROs. Each participating nursing home also fills in an institutional questionnaire to find out about their general characteristics, their antibiotics policy and the policy for infection-prevention and management. We also ask every nursing home for a list of the total antibiotics use in the past 12 months. By comparing the total antibiotic use at the nursing home with the measured prevalence figures, we can investigate the effect of exposure to antibiotics on the prevention of resistance.
Finally, we link this study to a pilot study; surveillance of the sewage water. In this way, the antimicrobial resistance in waste water is measured, in (a subset of) the participating nursing homes. That way, we can investigate whether there is a connection with the observed prevalence figures of MDRO carriage in the residents.
*MRSA: Methicillin-Resistant Staphylococcus aureus
**ESBLE: Extended Spectrum Beta-Lactamase producing Enterobacterales
***CPE: Carbapenemase Producing Enterobacterales
****VRE: Vancomycin Resistant Enterococci
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