Impact of Prescription Quality, Infection Control and Antimicrobial Stewardship on Gut Microbiota Domination by Healthcare-Associated Path.

Vancomycin-resistant enterococci (VRE), ESBL Enterobacteriaceae (EPE), and Clostridium difficile have become a threat to hospitalised patients worldwide. Although surveillance and control programmes are in place in many countries, the impact of the VRE/EPE/C. difficile epidemic on individual patients entering the healthcare system is poorly understood. There is a scarcity of trials defining the impact of the VRE/EPE/C. difficile epidemic on individual patients newly entering the healthcare-system. It is unknown to what degree infection Control (IC) and antimicrobial stewardship (AMS) interventions can disrupt the presumed chain of events (acquisition, colonization, antibiotic selective pressure, and intestinal domination) leading to infections with these microorganisms. Herein, we describe a comprehensive, multinational, multi-centre clinical study programme to elucidate the impact of the VRE/EPE/C. difficile epidemic on patients at high risk of healthcare-associated infections, during which we will observe the clinical and pathophysiological events leading to infection, analyse the preventative potential of IC and AMS, establish the preventable burden of these microorganisms, and better understand when and why AMS/IC measures are not always effective. Centrepieces of the study will be rating of adequateness of antibiotic treatments by an international AMS-board and in-depth analysis of intestinal microbiota before and after antibiotic exposure. We hypothesize that receiving inadequate treatment places patients at high risk of intestinal domination and thus infection by these microorganisms. Further analyses will address costeffectiveness of specific interventions, behavioural analyses of the decision process leading to inadequate antibiotic treatment, and the rate of undetected previous colonization by EPE/VRE/C. difficile falsely attributed as hospital-acquired when conventional screening methods are used. Recruitment of patients at all the four participating hospitals in Norway (University Hospital of North Norway, Haukeland University Hospital, AHUS and Stavanger University Hospital) was completed in the spring of 2021. In accordance with the protocol, each Norwegian hospital has recruited 100 patients and the total cohort from Norway is thus 400 patients. The hospitals have chosen somewhat different strategies for recruitment adapted to local circumstances. Due to the pandemic, the international project has prolonged the recruitment period until the summer of 2021. We will now begin with microbiological and statistical analyses of the results.

Det er for tidlig å vurdere oppnådde og potensielle virkninger og effekter av resultatene, dette må avvente til materialene er ferdig analysert.

Vancomycin-resistant enterococci (VRE), ESBL Enterobacteriaceae (EPE), and Clostridium difficile have become a threat to hospitalised patients worldwide. Although surveillance and control programmes are in place in many countries, the impact of the VRE/EPE/C. difficile epidemic on individual patients entering the healthcare system is poorly understood. There is a scarcity of trials defining the impact of the VRE/EPE/C. difficile epidemic on individual patients newly entering the healthcare-system. It is unknown to what degree infection Control (IC) and antimicrobial stewardship (AMS) interventions can disrupt the presumed chain of events (acquisition, colonization, antibiotic selective pressure, and intestinal domination) leading to infections with these microorganisms. Herein, we describe a comprehensive, multinational, multi-centre clinical study programme to elucidate the impact of the VRE/EPE/C. difficile epidemic on patients at high risk of healthcare-associated infections, during which we will observe the clinical and pathophysiological events leading to infection, analyse the preventative potential of IC and AMS, establish the preventable burden of these microorganisms, and better understand when and why AMS/IC measures are not always effective. Centrepieces of the study will be rating of adequateness of antibiotic treatments by an international AMS-board and in-depth analysis of intestinal microbiota before and after antibiotic exposure. We hypothesize that receiving inadequate treatment places patients at high risk of intestinal domination and thus infection by these microorganisms. Further analyses will address costeffectiveness of specific interventions, behavioural analyses of the decision process leading to inadequate antibiotic treatment, and the rate of undetected previous colonization by EPE/VRE/C. difficile falsely attributed as hospital-acquired when conventional screening methods are used.