Wolfgang R.Heizmann
Orgamed Consulting / University of Tübingen, Germany
Title: To screen or not to screen?
Biography
Biography: Wolfgang R.Heizmann
Abstract
The avoidance of nosocomial infections is the main goal of hospital hygiene. There are two prominent sources of pathogens causing infections: exogenous and endogenous. An example of an exogenous infection is the acquisition of a pathogen from other patients or from the environment. To combat this source, guidelines and “bundles” of measurements are able to reduce the number of cases. However, endogenous nosocomial infections e.g. resulting from the microbiome of the gut are much more challenging. In the area of rising numbers of multiresistant bacteria (MRB), especially Gram-negative species producing ESBL’s or carbapenemases, the chance to acquire an infection caused by one of these organisms is also increasing. Many of the MRB’s are Enterobacteriaceae and reside in the gut of apparently healthy people. Admission to the hospital e.g. caused by a diabetic foot, may result in an in endogenous nosocomial infection by these MRB’s. It is now accepted that early adequate antimicrobial therapy is able to decrease mortality. However, even in the area of rapid methods for identification of bacteria and detection of the most important resistance mechanisms, in many cases results of susceptibility testing needs up to 72h. Therefore it is of utmost importance to know the risk in a given patient for the possibility of a MRB infection. Consequently it seems rational to screen for colonisation with MRB’s not only patients in so called risk groups, but all patients at least at admission. The question arises which method is best and at what costs.