Twenty years of antimicrobial resistance control programme in a regional multi hospital institution, with focus on emerging bacteria (VRE and CPE)

AP-HP MDR programme consisted in successive waves of actions: bundle measures to survey and control cross transmission of MRSA and extended-spectrum betalactamase producing enterobacteria (ESBL) in 1993, large campaign to promote the use of alcohol-based hand rub solution (ABHRS) in 2001, specific strategy to quickly control the spread of emerging MDR (vancomycin resistant Enterococcus, VRE; carbapenemase producing enterobacteria, CPE) in 2006, large campaign to decrease antibiotics consumption in 2006.Following this programme, the ABHRS consumption dramatically increased, the antibiotic consumption decreased by 10%, the incidence of MRSA, including MRSA bacteraemia, decreased by 2/3, all VRE and CPE events were rapidly controlled. However, the incidence of ESBL, mainly Klebsiella pneumoniae and Escherichia coli, that remained low and stable until 2003 increased markedly afterwards, justifying adapting our programme in the future.A sustained and coordinated strategy can lead to control multidrug resistant bacteria at the level of a large multihospital institution.Multidrug resistance bacteria (MDR) jeopardizes the quality of care by (a) complicating the treatment of healthcare associated infections (HAI) and (b) increasing the incidence of HAIs (e.g. in the case of methicillin resistant Staphylococcus aureus, MRSA). Emergence of vancomycin-resistant enterococci (VRE) and carbapenemase-producing enterobacteria (CPE) is nowadays a major public health concern worldwide [1]. In 1993 Assistance Publique-H？pitaux de Paris (AP-HP), the largest public health care institution in France, launched a long term programme to survey and control MDR.AP-HP is a public health institution administering 38 teaching hospitals (23 acute care and 15 rehabilitation/long-term care hospitals, spread over Paris, suburbs and surrounding counties), totalizing 23,000 beds (10% of all public hospital beds in France) and serving 11.6 millions of inhabitants. AP-HP admits approximately 1 million in