Impact of Prescription Quality, Infection Control and Antimicrobial Stewardship on Gut Microbiota Domination by Healthcare-Associated Pathogens
Surveillance
Transmission
- Jörg Janne Vehreschild, University Hospital of Cologne, Germany (Coordinator)
- Noa Eliakim Raz, Rabin Medical Center, Israel (Partner)
- Uga Dumpis, University of Latvia, Latvia (Partner)
- Gunnar Skov Simonsen, University Hospital of North Norway, Norway (Partner)
- Christian Giske, Karolinska Institutet, Sweden (Partner)
- Makeda Semret, McGill University Health Centre (MGU), Canada (Partner)
The gut flora includes millions of bacteria and other microorganisms which naturally contribute to keep the human body healthy. It is mainly located in the colon (large intestine). Alimentary habits, diseases, and the use of antibiotics or other drugs may modify the number and type of bacteria in the gut flora. Antibiotics save many lives by curing patients with bacterial infections such as pneumonias or urinary infections. After oral or intravenous administration, antibiotics enter the bloodstream, are transported to the site of infection (for example, in the lungs or in urine) and kill the bacteria causing the infection. Small amounts of antibiotics also reach the colon and the bacteria of the gut flora. There, some bacterial species may be killed; other species may abnormally overgrow, resulting in domination of the flora, or become resistant to antibiotics. The number of antimicrobial resistant bacteria has increased dramatically among patients worldwide. So-called vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase producing Enterobacteriaceae (EPE) are a large threat for hospitalised patients worldwide. Similarly, the burden of “healthcare associated” infectious diarrhoea caused by a Clostridium difficile infection (CDI) has increased as well, resulting in longer treatments and higher risks for re-hospitalisation. For these reasons, it is important to use antibiotics only when they are really needed. If an antibiotic is required, it should be carefully selected to be effective against the bacteria causing the infection while preserving the healthy gut flora as much as possible. There are initiatives that support doctors in choosing the best antibiotic by training, educational materials and prescription regulations, called Antimicrobial Stewardship. Another approach to reduce the spread of multi-resistant bacteria are hygiene and infection control measures. However, these measures come with considerable cost and effort during a time of limited healthcare resources. It remains unknown which measures are the most effective to prevent spread of resistance bacteria and ensure optimal antibiotic treatment. We also need more information on how much antibiotics contribute to spread of EPE, VRE and C. difficile and whether appropriate, rational antibiotic use could help improving the current situation. The objective of the present PILGRIM study is to - determine the impact of antimicrobial prescription on the gut flora by EPE or VRE or infection with C. difficile - determine how often and when gut colonization by EPE or VRE and/or C. difficile occurs in-hospital or before admission - determine what measures (e.g. Infection Control or Antimicrobial Stewardship) are the most effective strategies to prevent healthcare-acquired colonization and infection by VRE, EPE, and C. difficile.
