Extensive specialization and concentration of care, with patients more often having to travel to a different hospital for aspects of their treatment, increase the chances of an outbreak of dangerous, resistant bacteria. This is the conclusion of UMCG researcher Tjibbe Donker in his PhD thesis. Patients who travel from one hospital to another, for example because a certain treatment or part of a treatment is only available in a particular hospital, influence the transmission of resistance to antibiotics. Thus, when the referral patterns and care use change, this will also influence the spread of resistant bacteria. Donker was awarded a PhD by the University of Groningen on 24 February.
Resistant bacteria are ‘ordinary’ bacteria that have become insensitive to antibiotics. An ordinary infection, for example cystitis, can be potentially life-threatening due to resistant bacteria because there are few if any alternative treatment options. The increase in antibiotic resistance is a global public health risk. In Dutch hospitals in recent years there have been several outbreaks of resistant bacteria, such as MRSA, VRE, Klebsiela and ESBL. These bacteria are particularly dangerous for people who are vulnerable to infection, like patients in hospitals. Preventing the spread of resistant bacteria within hospitals is thus a priority.
Hospitals which have patients moving between them form a kind of network. However, not only patients but also the bacteria they are carrying change location. When all the patient movements in a country are tracked, a complex network of hospitals and other care institutions is revealed clearly showing that some hospitals are more strongly rooted in that network than others. It also becomes clear that there are groups of hospitals in each region that mainly exchange patients with each other rather than being linked to other regions.
This network not only reveals how resistant bacteria spread, it also highlights solutions that can stem the spread. By keeping the regional hospital groups intact and not sending patients to medical centres outside that region, an outbreak of dangerous bacteria could be contained. Within the network it will be easy to select certain hospitals to function as monitoring points, or for extra investment in infection prevention. Swiftly signalling an outbreak would mean that adequate measures could be taken quickly in order to prevent further spread. That could result in significant health benefits, and substantial cost savings.
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