Assistance Publique-Hopitaux de Paris (APHP), the largest public healthcare institution in France (38 hospitals, 23,000 beds, serving 11.6 millions inhabitants) launched in 1993 a long-term program to control and survey multidrug-resistant bacteria (MDR). The AP-HP MDR program launched in successive waves of actions: bundle measures to survey and control cross-transmission of MRSA and extended-spectrum betalactamase producing enterobacteria (ESBL) in 1993; a large campaign to promote the use of alcohol-based handrub solution (ABHRS) in 2001; a specific strategy to quickly control the spread of emerging MDR (vancomycin resistant Enterococcus (VRE) and carbapenemase producing enterobacteria (CPE) in 2006; and a large campaign to decrease antibiotics consumption in 2006.
Sandra Fournier, of the Direction de la Politique Médicale, Assistance publique - Hôpitaux de Paris (AP-HP), and colleagues, report that following this program, the ABHRS consumption dramatically increased, the antibiotic consumption decreased by 10 percent, the incidence of MRSA, including MRSA bacteraemia, decreased by two-thirds, and all VRE and CPE events were rapidly controlled. However, the incidence of ESBL, mainly Klebsiella pneumoniae and Escherichia coli, remained low and stable until 2003 and increased markedly afterwards, thus justifying adapting the program in the future, the researcehrs say. They emphasize that a sustained and coordinated strategy can lead to control multidrug resistant bacteria at the level of a large multi-hospital system. Their research was published in Antimicrobial Resistance and Infection Control.
Reference: Fournier S, Brun-Bruisson C and Jarlier V. Twenty years of Antimicrobial Resistance control programme in a regional multi hospital institution, with focus on emerging bacteria (VRE and CPE). Antimicrobial Resistance and Infection Control 2012, 1:9 doi:10.1186/2047-2994-1-9