Care Infections & Antibiotic Resistance in Belgium

This activity report provides an overview of the most recent evolutions in healthcare associated infections and antimicrobial resistance in Belgium. The positive downward trend we have been observing for many years in the incidence of Methicillin Resistant Staphylococcus aureus (MRSA) in acute care hospitals appears to be stabilizing in 2016. The hand hygiene campaigns held biannually since 2005, which reduce -among many other initiatives- the spread of these bacteria through direct contact, contribute to this evolution. Also in intensive care units hand hygiene compliance increased significantly and the incidence of pneumonia following intubation has reduced remarkably. Other resistant bacteria, mainly present as a reservoir in the digestive tract (gut), are however on the rise and can cause severe bloodstream infections. In particular, Carbapenemase-Producing Enterobacteriaceae (CPE) and Vancomycin-Resistant Enterococci (VRE) are increasingly being isolated and have caused outbreaks in several hospitals. The number of Clostridium difficile infections (severe enteritis and colitis) also slightly increased since 2014, although its associated mortality decreased. In long-term care facilities (among others nursing homes), similar evolutions are taking place (decrease in MRSA, increase in multi-resistant gut bacteria). Long term monitoring shows a recent slight decrease in antimicrobial consumption in the ambulant sector but alas not in the hospitals. Antimicrobial use should urgently be further optimized in our healthcare facilities in order to control the selection pressure for antimicrobial resistance. Since 2014 and in collaboration with the inspection services of the competent authorities, assistance is being offered to hospitals and long-term care facilities that suffer from difficult to treat bacteria in the form of an outbreak support team (MDRO – OST; Multi-Drug Resistant Organisms - Outbreak Support Team). In the period 2014-2016, 13 out of 15 reported outbreaks where assistance was granted, containment was achieved within a reasonable time frame.