Since 1994 the service “Healthcare-associated infections and antimicrobial resistance” of Sciensano (the former Belgian Scientific Institute of Public Health) closely monitors antimicrobial resistance in Belgian acute care hospitals. At present, hospitals can participate in three national, multicentric and continuous surveillance programs, i.e. (1) methicillin resistant Staphylococcus aureus (MRSA), (2) multiresistant Gram-negative bacteria (MRGN), and (3) resistant enterococci. All Belgian acute care hospital mandatorily have to participate in the surveillance of MRSA and MRGN.
The aim of the current report is to present the 2016 results of the three epidemiological surveillance programs and to describe trends in the antimicrobial resistance in Belgian acute and/or chronic care hospitals.
The data presented in this reported were collected retrospectively (year 2016) and were aggregated at hospital level. Hospitals could either provide annual figures or data for one semester, except for the surveillance of resistant enterococci for which solely annual data were allowed.
Only hospitals providing Type D data (with de-duplication) were included in the analyses, i.e. per period of hospitalisation and bacterium each patient should only be counted once. Clinical samples and screening samples originating from hospitalized patients could be included.
In total, 140 hospitals were included in the analyse of the MRSA surveillance results: 123 acute care hospitals and 17 chronic care hospitals. The mean proportion of MRSA (among S. aureus isolates) was 15.7% in acute care hospitals and 29.1% in chronic care hospitals.
The mean incidence of nosocomial MRSA in acute care hospitals was 0.93 cases per 1 000 admissions. The incidence is significantly decreasing since 2003 and currently is at its lowest level since the start of the surveillance in 1994. In chronic care hospitals the mean incidence density stayed at the same level as in 2015 (0.14 cases per 1 000 patient days).
In acute and chronic care hospital 50.1% and 41.3% of all nosocomial MRSA cases were detected through screening, respectively.
One hundred and five hospitals participated to the optional surveillance of resistance in enterococci. Data were combined for acute and chronic care hospitals. The mean incidence of vancomycin and linezolid resistant Enterococcus faecium (E. faecium) was low: 0.140 and 0.009 cases per 1 000 admissions, respectively. Because of the recent character of the surveillance it is too early to see clear trends in the evolution graph of E. faecium.
In total, 122 acute care hospitals and 16 chronic care hospitals were included for the MRGN surveillance. The surveillance shows a unfavorable trend in the evolution of resistance in Enterobacteriaceae, especially in Klebsiella pneumoniae (K. pneumoniae) in acute care hospitals. The mean resistance proportion of extended beta-lactamase producing (ESBL+) K. pneumoniae increased from 6.2% in 2005 to 17.9% in 2016 in acute care hospitals. In chronic care hospitals ESBL resistance in K. pneumoniae rapidly increased between 2011 and 2013 but remained stable since then (19.9% in 2016).
While the mean incidence of ESBL resistance in acute care hospitals was much higher in Escherichia coli (E. coli; 4.69 cases per 1 000 admissions) compared to K. pneumoniae (2.53 cases per 1 000 admissions), the incidence of carbapenemase production (CPE+) and reduced susceptibility for meropenem (meropenem I/R) was higher in K. pneumoniae (0.15 and 0.24 cases per 1 000 admissions, respectively) compared to E. coli (0.03 and 0.01 cases per 1 000 admissions, respectively).
The resistance proportion of meropenem I/R Acinetobacter baumannii (A. baumannii) in acute care hospitals increased from 4.2% in 2015 to 6.1%, while the mean incidence remained the same (0.03 cases per 1 000 admissions in 2016).
The mean resistance proportion of Multi-drug resistant (MDR) Pseudomonas aeruginosa (P. aeruginosa) remains stable since 2013 (5.5% in 2016), while the incidence in acute care hospitals slowly decreases (0.69 cases per 1 000 admissions in 2016).
In chronic care hospitals the mean resistance proportion of both meropenem I/R A. baumannii (10.1%) and MDR P. aeruginosa (8.7%) was higher than in acute care hospitals. In 2016 the mean incidence of meropenem I/R A. baumannii (0.005 cases per 1 000 patient days) was lower than the mean incidence of MDR P. aeruginosa (0.13 cases per 1 000 patient days).
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