Abstract
The funding of preventive care in general is under pressure. Costs are substantial and concrete in the budgets, while the return on these investments cannot easily be accounted for, so they often disappear in the annual financial reports. Undeservedly, because the money spent for the purpose of prevention does have a considerable return. In the field of infection prevention, you may need an important outbreak once in a while to help remember that. The huge outbreak of a carbapenemase-producing Klebsiella pneumoniae that hit the Maasstad Hospital in Rotterdam so hard in the years 2009–2011 was in that sense a cloud with a silver lining. The very poorly functioning departments for medical microbiology and infection prevention in the hospital in Rotterdam were not only unable to stop the outbreak at an early stage, but they also tried to hide it from the outside world. Ultimately the costs of the outbreak—and the additional negative publicity—therefore were sky-high.
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Notes
- 1.
NOS (Nederlandse Omroep Stichting): the largest public radio and television broadcaster (news broadcaster) in the Netherlands.
- 2.
NDM-1 and OXA-48 are carbapenemases—enzymes that possess the ability to neutralise the effects of antibiotics belonging to the class of carbapenems. Carbapenems are potent antibiotics with few side effects. They are used as last resort drugs. Resistance to carbapenems is often combined with resistance to other beta-lactam antibiotics such as penicillin and cephalosporins. In case of carbapenem resistance, there are only a few medicines left, which are either much more toxic, less effective, or both.
- 3.
RIVM (Rijksinstituut voor Volksgezondheid en Milieu, National Institute for Public Health and the Environment), comparable to the Public Health England (PHE) Centre of Disease Surveillance and Control (EPIET) in the United Kingdom and the CDC in the United States.
- 4.
In an e-mail to the author, Winfred Schop, at the time teammanager infectious diseases at the local health authority (GGD) in Rotterdam writes: ‘The GGD in Rotterdam-Rijnmond received seven reports about patients who were transferred from the Maasstad Hospital to other healthcare institutions, and who also proved to be infected with OXA-48 Klebsiella afterwards. In two cases a hospital was involved, the other five affected retirement homes and nursing homes’.
- 5.
This involved a PCR test. PCR stands for ‘polymerase chain reaction’. With the aid of the test, enough material can be extracted from a few DNA molecules to analyse it.
- 6.
The WIP was a joint venture between the Netherlands Society for Clinical Microbiology, the Society for Infectious Diseases and the Society for Hygiene and Infection Prevention in Healthcare. It ceased its activities on 1 June 2017, after struggling financially for over 2 years. Neither hospitals nor the Ministry were willing to give the WIP sufficient funding. The Minister of Health—at that time Ms. Edith Schippers—asked the national health institute, the RIVM, to create a new structure for the work that the WIP had done up till then, and to coordinate the efforts of all parties involved. End March 2021 the WIP still not has been replaced by a new structure.
- 7.
Grootendorst resigned from his posts as Director of Medical Staff and Head of the Intensive Care Unit in 2012. He has continued to work for several years in the hospital’s intensive care unit.
- 8.
Six patients with enterobacter cloacae with OXA-48, six with Klebsiella oxytoca with OXA-48, five with morganella morgannii with OXA-48, three with citrobacter freundii with OXA-48. In addition to this, nine more types of bacteria with OXA-48 were identified, each of them in one or two patients. Forty-nine patients were carriers of more than one type of OXA-48 bacteria.
- 9.
The genetic information in which this form of antibiotic resistance is encoded is located on a plasmid, a separate, circular piece of DNA. This makes it possible to pass on the information to other bacteria, including those of other species.
- 10.
A VITEK is a system that makes it possible to test which antibiotics a bacterium is susceptible to.
- 11.
‘Dark grey suspicious cases’ are patients whose risk of infection with an OXA-48 Klebsiella was estimated to be the highest—in contrast to light grey suspicious cases, whose risk was lower. ‘White patients’ are not carriers. ‘Black patients’ are carriers, or infected with OXA-48 Klebsiella.
- 12.
The type in question is CTX-M-15. CTX-M-15 is also an enzyme.
- 13.
The minimum inhibitory concentration (MIC) is the lowest concentration of a medicine that can still inhibit the growth of a bacterium.
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van den Brink, R. (2021). Major Outbreak at Maasstad Hospital. In: The End of an Antibiotic Era. Springer, Cham. https://doi.org/10.1007/978-3-030-70723-1_4
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