Outi Lyytikäinen, THL: Surveillance and outbreak investigations of multi-drug-resistant microbes (MDR)

1. OUTBREAK INVESTIGATIONS OF
MULTI-DRUG RESISTANT
MICROBES
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Outi Lyytikäinen, research professor
Finnish Hospital Infection Program (SIRO)
Department of Health Security
National Institute for Health and Welfare (THL)

2. Antimicrobial resistance in Finland
 Antimicrobial resistance (AMR) situation in Finland still
rather good.
 Worsening of the resistance situation
 Certain multi-drug resistant (MDR) microbes are an
increasing threat such as MRSA, VRE, ESBL and CPE.
 Continuously clusters and outbreaks in healthcare
facilities, both in acute and long-term care as well as in
healthcare center wards (post-acute care and
rehabilitation)
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3. Controlling AMR
 National action plan on AMR
– Ministry of Social Affairs and Health, 2017
– Tasks for National Institute for Health
and Welfare (THL)
 Developing surveillance and
surveillance indicators
– Antimicrobial resistance
– Antimicrobial consumption
– Healthcare-associated infections
 Controlling spread and prevention of
infections
– Outbreak investigations
– Guidelines
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4. Outbreak investigations
 THL supports outbreak investigations
– Provides typing data for bacteria in order to detect outbreaks and
trace back transmission routes
– Typing done only by THL, no competence or interest elsewhere
– Consultation in control measures
 News communication channel (HARVI): Aim is to support
information flow between different actors in order to implement
appropriate control measures timely and detect common
threats.
 Severe case and suspected outbreaks caused by extremely
drug-resistant microbes when consultation is needed
(Communicable Disease Act 36§).
 Notifications by local or regional authority or expert (infectious
disease physician or infection control/public health nurse) or
head of a long-term care facility
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5. 6/13/2019 Outbreak investigations 5

6. 6/13/2019
- 2 CPE clusters 2013-2018 involving 6 healthcare
facilities (HCF)
- 20 CPE cases, 16 found in clinical specimens and
four in screening
Cluster 1: 18 cases in 5 HCFs, index case unknown link
abroad, 6/18 the same room different time,
environmental specimens negative
• HCF A: 3 cases 2013, 2016, 2017
• HCF B: 1 case 2014
• HCF C: 8 cases 2015-2017
• HCF D: 4 cases 2016-2018
• HCF E: 2 cases 2017, 2018
Cluster 2: 2 cases, index case transferred from Italy,
the same room different time (8 months), contaminated
toilet
• HCF F: 2 cases 2015 and 2016
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7. Infection prevention guidelines
 National guidelines in
controlling multi-drug
resistant microbes including
MRSA, VRE, ESBL, CPE,
MDR-Pseudomonas, MDR-
Acinetobacter
– update autumn 2019 i.e.,
Candida auris, terminal
cleaning
 Control of healthcare-
associated infections -text book
(publisher THL, 2018)
 Infection prevention guidelines
for healthcare facilities at THL
website
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