National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: a 9 year experience Anne Carbonne 1 *, Isabelle Arnaud 1 , Sylvie Maugat 2 , Nicole Marty 3 , Catherine Dumartin 4 , Xavier Bertrand 5 , Odile Bajolet 6 , Anne Savey 7 , Thierry Fosse 8 , Mathieu Eveillard 9 , He ´le `ne Se ´ne ´ chal 10 , Bruno Coignard 2 , Pascal Astagneau 1 and Vincent Jarlier 11,12 on behalf of the MDRB Surveillance National Steering Group (BMR-Raisin)† 1 CCLIN Paris Nord, rue Didot, 75014 Paris, France; 2 InVS, rue du val d’Osne, 94415 Saint-Maurice, France; 3 University Hospital, rue Vuguerie, 31059 Toulouse cedex 9, France; 4 CCLIN Sud Ouest, GH Pellegrin, 33076 Bordeaux, France; 5 University Hospital, place Saint Jacques, 25000 Besanc ¸on, France; 6 University Hospital, 51092 Reims cedex, France; 7 CCLIN Sud-Est, hospital Henry Gabrielle, route de Vourles, 69230 Saint Genis Laval, France; 8 University Hospital, Ave Reine Victoria, 06003 Nice cedex 1, France; 9 University Hospital, rue Larrey, 49933 Angers cedex 9, France; 10 CCLIN Ouest, University Hospital Ho ˆtel Dieu, rue de l’Ho ˆtel Dieu, 35000 Rennes, France; 11 Bacte ´riologie-Hygie `ne, UPMC University Paris 6, EA1541, 75634 Paris cedex 13, France; 12 Bacte ´riologie-Hygie `ne, Groupe Hospitalier Pitie ´-Salpe ˆtrie `re Charles Foix (Assistance Publique-Ho ˆpitaux de Paris), 75651 Paris cedex 13, France *Corresponding author. Hygie `ne Hospitalie `re, Groupe Hospitalier Corentin Celton/HEGP/Vaugirard Gabriel-Pallez, 20-40 rue Leblanc, 75908 Paris cedex 15, France. Tel: +33-1-56-09-29-73; Fax: +33-1-56-09-39-19; E-mail: anne.carbonne@egp.aphp.fr †The other members are listed in the Acknowledgements section. Received 2 August 2012; returned 11 September 2012; revised 5 October 2012; accepted 23 October 2012 Background: In the mid-1990s, the prevalence rate of multidrug-resistant bacteria (MDRB) in French hospitals was high and control of MDRB spread then became a major priority in the national infection control programme (ICP). Methods: To evaluate the impact of the ICP, a national coordination of MDRB surveillance was set up in 2002. Data were collected 3 months a year in healthcare facilities (HCFs) on a voluntary basis. All clinical specimens of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum b-lactamase-producing Enterobac- teriaceae (ESBLE) were prospectively included. Incidences per 1000 patient days (PDs) were calculated and trends in incidence from 2003 to 2010 were assessed. Results: Participation in the surveillance increased from 478 HCFs in 2002 to 933 in 2010. In 2010, MRSA inci- dence was 0.40/1000 PDs: 1.14 in intensive care units (ICUs), 0.48 in acute care facilities (ACFs) and 0.27 in rehabilitation and long-term care facilities (RLTCFs). ESBLE incidence was 0.39/1000 PDs: 1.63 in ICUs, 0.46 in ACFs and 0.23 in RLTCFs. MRSA incidence significantly decreased from 0.72/1000 PDs in 2003 to 0.41/ 1000 PDs in 2010 (P , 10 23 ); in contrast, ESBLE incidence significantly increased from 0.17/1000 PDs to 0.48/1000 PDs (P , 10 23 ). The most prevalent ESBLE were Enterobacter aerogenes (34%) and Escherichia coli (25%) in 2003 and E. coli (60%) and Klebsiella pneumoniae (18%) in 2010. Conclusion: These results demonstrate the positive impact of the national ICP on MRSA rates. In contrast, ESBLE incidence, especially ESBL-producing E. coli, is increasing dramatically and represents a serious threat for hospitals and for the community that deserves specific control actions. Keywords: MRSA, ESBLE, prevention, programme, healthcare setting Introduction Over recent decades, multidrug-resistant bacteria (MDRB) have had a significant clinical impact, have been linked with higher mortality and have led to additional financial burden. 1 Among MDRB, methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLE) are of immediate concern, given their pathogenicity and the risk of their spread in healthcare settings. In addition, the carriage of MRSA and ESBLE can last for several months, even after hospital discharge, enhancing the risk of dissemin- ation in the community. 2 The incidence of MRSA and ESBLE is primarily the consequence of patient-to-patient transmission in healthcare settings and, in part, in the community, and is # The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com J Antimicrob Chemother 2013; 68: 954–959 doi:10.1093/jac/dks464 Advance Access publication 29 November 2012 954 at Assistance Publique Hopitaux de Paris on April 15, 2013 http://jac.oxfordjournals.org/ Downloaded from