[Evaluation of antibiotic resistance in the frame of the surveillance system for nosocomial infections. Strong and weak points].

Abstract

Since 2005 a sentinel system for surveillance of nosocomial diseases has been introduced in Romania which had, among other objectives, the evaluation of antibiotic resistance. The surveillance methodology was shared annually, the number of participants varying between 12 and 40 hospitals. During 2005-2008 the Reference Laboratory for Nosocomial Infections and Antibiotic Resistance in the "Cantacusino" NIRDMI received 1481 bacterial strains, comprising 531 S. aureus, 486 Pseudomonas aeruginosa, 439 enterobacteria and 25 enterococci strains. The resistance percents widely differred for some species, especially regarding the type of hospital unit that sent the strains (ex., Pseudomonas aeruginosa isolated form patients with burns). A great variability was noted concerning the manner in which nominalized hospitals responded to the solicitations in the methodology that was shared. especially regarding participation to a national bank for bacterial strains. Only for 5 out of the 40 hospitals that participated along the 4 years in the sentinel programme the annual comparative evaluations of antibiotic resistance were achieved. for a small number of microorganisms that underwent surveillance (S. aureus, E. coli). Among the strong points of the system we can point out: unity in methodology; working protocols for microbiological investigation given to all the participants; special forms for reporting. Among the weak points, we consider: modification in the number of participant hospitals during the program: unequal participation of hospitals, with unwanted effects on the sample representativity of analysed microbial strains; difficulties in stocking and processing laboratory data. In order to increase the quality of data provided, we consider the following as useful: harmonization of the objectives regarding integrated surveillance of nosocomial infections and antibiotic resistance in hospital environment, correlated with the ECDC demands and recommendations; inclusion in the system of sanitary units that fit the needs of the program fir microbiological identification and investigation of nosocomial infections; intensification of the training activities of persons involved in the program, regardless of the level of responsibility and the acknowledgement of each person's responsibilities in nosocomial infection monitoring; external and internal control implementation in the laboratories: selection of aspects concerning the emergence and spread of antibiotic resistance that come out during surveillance in order to be studied using molecular methods for the emphasizing of mechanisms and causes, in view of implementing measures for prevention and control; evaluation of the necessity for molecular investigation in view of identifying resistant bacterial clones in the hospitals in Romania etc.