Contamination with resistant bacteria in patients admitted to Dutch hospitals does not result in higher mortality than contamination by non-resistant bacteria. Although the problem of antibiotic resistance in the Netherlands currently seems manageable, it is important to remain vigilant in view of the ever-changing epidemiology of resistant bacteria, according to Wouter Rottier, who was awarded a PhD in Utrecht on February 19.
Antibiotic resistance is an increasing problem worldwide. Many people in the Netherlands also carry bacteria that cannot adequately be cured with conventional antibiotics. Some studies have suggested that antibiotic resistance is also a problem in the Netherlands and leads to extra mortality. The problem with research on antibiotic resistance is that the context of policies on antibiotic use and diagnostic procedures must also be included in the analysis and interpretation of studies. The way in which this is discounted determines to a large extent the study outcome.
No increased mortality
Investigator Wouter Rottier investigated during his doctoral research at UMC Utrecht what the consequences are if people incur infections with resistant bacteria. Therefore, infections in patients in 8 Dutch hospitals were divided into two groups, namely infections caused by (1) resistant bacteria and (2) infections caused by the usual, non-resistant variants of those bacteria. Subsequently, these groups were compared on various outcomes. Rottier found that in case of infection with resistant bacteria, it takes longer for doctors to prescribe the right type of antibiotics. However, this delay does not lead to an inferior outcome for the patient: the mortality due to infection with resistant bacteria does not appear to be higher than in infection with sensitive bacteria.
Use spare antibiotics to reduce
In addition, this PhD research addressed the question of how to anticipate resistant bacteria when a doctor prescribes antibiotics for a patient with a severe infection. At the early stage of an infection it is usually unknown which bacterium is the cause and the outcome of laboratory results can take hours to days. In such a case, Dutch guidelines state that with the aid of certain criteria, an assessment must be made of which antibiotics will work best for an individual patient. However, Rottier’s research shows that this strategy leads to significant unnecessary use of reserve antibiotics. By extending the number of factors to be weighed up, a better estimate of the likelihood of resistant bacteria can be made. With this information, undesirable use of reserve antibiotics can be reduced.
Wouter Rottier: “We argue that in future research into antibiotic resistance relevant factors such as timely diagnosis, adequate use of antibiotics and the patient’s response should be taken into account. A better understanding of this provides us with tools to be able to reduce the problem in countries with a relatively high mortality due to infections with resistance bacteria. ”
Wouter Rottier (Soest, 1989) was awarded a PhD by Utrecht University on 19 February 2019 for the dissertation “Quantifying the burden of antibiotic resistance in the Netherlands” The supervisor was Prof. dr. M.J.M Bonten (Laboratory for Medical Microbiology, UMC Utrecht); co-supervisor was Dr. H.S.M. Ammerlaan (Department of Internal Medicine, Catharina Hospital, Eindhoven).
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