The issue of multidrug-resistant organisms (MDROs) proves a significant challenge to the global healthcare community. Among these challenges, the Netherlands boasts one of the lowest rates of antimicrobial resistance across the world. This is in part due to prudent antibiotic use, and also a result of stringent infection prevention and control measures implemented in Dutch healthcare facilities. The Netherlands’ success pivots on an updated national guideline for managing and preventing MDROs in hospitals developed by their domestic industry consortium, Dutch Collaborative Partnership for Infection Prevention Guidelines (SRI).
The methodology behind the guideline includes a multidisciplinary approach and evidence-based frameworks like AGREE-II and GRADE. The new guideline defines MDRO, provides risk assessment, recommendations for MDRO screening, isolation, infection prevention measures, source and contact tracing, discontinuation of isolation measures, and organization of care. It adds new evidence and includes aspects like patient perspectives, sustainability, costs, and organizational factors to its insights. In addition, it provides practical advice for countering MDRO transmission. The aim of this revision is to fortify national infection control practices and maintain the country’s low levels of antimicrobial resistance.
The Netherlands flaunts its successes against antimicrobial resistance, crediting its win to a conservative use of antibiotics and extremely effective control measures for infections in healthcare facilities. Outlined in these national guidelines and overseen by the Dutch Health and Youth Care Inspectorate, the Dutch have had a tight grip on MDROs since their initial guideline publication in 2005, updated in 2012, primarily focusing on IPC measures, which reduce nosocomial infections and limit pathogen transmission in healthcare facilities.
However, the guideline has seen updates since its last revision in 2012, with new insights into the defining criteria of MDRO and how infection prevention and control measures can be updated. The new guideline, under the care of SRI, details managing MDRO in specialty healthcare settings, except for MRSA and MDR-TB due to them being addressed separately.
The guideline was built on established recommendations for guideline development, such as the Appraisal of Guidelines for Research and Evaluation II (AGREE-II). Recommendations were carried forward from the original guidelines, expert opinions, and additional factors such as impacts of limited treatments on patient outcomes, organism transmissibility, and the effectiveness of IPC interventions.
The guideline revision also included the addition of Candida auris, which due to its high prevalence of antifungal resistance, is now classified as an MDRO regardless of susceptibility test results. However, some previously classified MDROs like Enterobacterales resistant to aminoglycosides and fluoroquinolones, are dropped from the list due to viable alternatives for treatment.
Meanwhile, AmpC beta-lactamase-producing Enterobacterales remain unclassified as MDROs due to advancements in diagnostic technologies that suggest these microorganisms aren’t highly transmissible enough to meet MDRO classifications. However, the dynamic nature of hospital-acquired bacteria still necessitates ongoing surveillance to ensure the prevention of outbreaks.
Ultimately, the Dutch model for handling MDRO shines as it exemplifies a risk-based screening policy for asymptomatic MDRO carriage upon admission. This policy targets known MDRO carriers or patients who have been in both foreign and other Dutch healthcare facilities during outbreaks. These steps aid in reducing patient to patient MDRO transmission while guiding the healthcare system towards an efficient, effective path to managing and mitigating MDRO infections.
Source: https://aricjournal.biomedcentral.com/articles/10.1186/s13756-025-01648-w