{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T12:05:43Z","timestamp":1768737943164,"version":"3.49.0"},"reference-count":24,"publisher":"SMW Supporting Association","issue":"2728","license":[{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Swiss Med Wkly"],"abstract":"AIM OF THE STUDY: The main objective of this study was to propose a common definition of multidrug-resistant gram-negative organisms (GN-MDRO), which may be used for epidemiological surveillance and benchmarking.\nMETHODS: In this retrospective data analysis, we used interpreted qualitative susceptibility data (SIR) from blood culture isolates of different gram-negative microorganisms from the ANRESIS database from 2017\u20132021. We first analysed testing algorithms used by different Swiss laboratories and investigated cross-resistance patterns within antibiotic groups. Comparing these data with existing international definitions, we developed two different GN-MDRO definitions, an extended one for surveillance purposes (ANRESIS-extended) and a more stringent one for clinical purposes, aimed primarily at the identification of difficult-to-treat GN-MDRO (ANRESIS-restricted). Using these novel algorithms, the rates of invasive GN-MDRO identified in our national dataset were compared with international and national definitions: the European Centre for Disease Prevention and Control (ECDC) definition, the Commission for Hospital Hygiene and Infection (KRINKO) definition and the definition proposed by the University Hospital Zurich.\nRESULTS: SIR data of a total of 41,785 Enterobacterales, 2,919 , and 419 spp. isolates were used for the analyses. Five antibiotic categories were used for our MDRO definition: aminoglycosides, piperacillin-tazobactam, third- and fourth-generation cephalosporins, carbapenems and fluoroquinolones. Large differences were found between the testing algorithms of the different laboratories. Cross-resistance analysis within an antibiotic group revealed that the substance most likely to be effective against a particular gram-negative bacterium was not preferentially tested (e.g. amikacin for the aminoglycosides). For all bacterial species tested, the highest rates of multidrug-resistant isolates were found using the ECDC-MDR definition, followed by the ANRESIS-extended definition. The number of MDR-Enterobacterales identified using the ANRESIS-restricted definition (n = 627) was comparable to those identified using the KRINKO (n = 622) and UHZ definitions (n = 437). However, the isolates classified as MDR-Enterobacterales according to the KRINKO, UHZ and ANRESIS-restricted definitions (total n = 870) differed considerably. Only 242 of the isolates (27.8%) were uniformly classified as MDRO according to the KRINKO, UHZ and ANRESIS-restricted definitions. Comparable findings were made for Klebsiella spp. and Pseudomonas aeruginosa.\nCONCLUSIONS: The application of different MDRO definitions leads to significant differences in not only MDRO rates but also the isolates that are eventually classified as MDRO. Therefore, defining a nationwide MDRO algorithm is crucial if data are compared between hospitals. The definition of a minimal antibiotic susceptibility testing panel would improve comparability further.<\/jats:p>","DOI":"10.4414\/smw.2022.w30195","type":"journal-article","created":{"date-parts":[[2022,7,1]],"date-time":"2022-07-01T11:36:03Z","timestamp":1656675363000},"page":"w30195","source":"Crossref","is-referenced-by-count":4,"title":["Retrospective data analysis for definition of multidrug resistance in gram-negative bacteria \u2013 a consensus proposal"],"prefix":"10.57187","volume":"152","author":[{"given":"Olivier","family":"Friedli","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"V\u00f6llmy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacques","family":"Schrenzel","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephan","family":"Harbarth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Kronenberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"36756","published-online":{"date-parts":[[2022,7,11]]},"reference":[{"key":"78230","doi-asserted-by":"crossref","unstructured":"Carlet J, Collignon P, Goldmann D, Goossens H, Gyssens IC, Harbarth S, et al. Society\u2019s failure to protect a precious resource: antibiotics. Lancet. 2011 Jul;378(9788):369\u201371. https:\/\/doi.org\/10.1016\/S0140-6736(11)60401-7<\/a>","DOI":"10.1016\/S0140-6736(11)60401-7"},{"key":"78231","doi-asserted-by":"crossref","unstructured":"Martens E, Demain AL. The antibiotic resistance crisis, with a focus on the United States. J Antibiot (Tokyo). 2017 May;70(5):520\u20136. https:\/\/doi.org\/10.1038\/ja.2017.30<\/a>","DOI":"10.1038\/ja.2017.30"},{"key":"78232","doi-asserted-by":"crossref","unstructured":"Tacconelli E, Sifakis F, Harbarth S, Schrijver R, van Mourik M, Voss A, et al.; EPI-Net COMBACTE-MAGNET Group. Surveillance for control of antimicrobial resistance. Lancet Infect Dis. 2018 Mar;18(3):e99\u2013106. https:\/\/doi.org\/10.1016\/S1473-3099(17)30485-1<\/a>","DOI":"10.1016\/S1473-3099(17)30485-1"},{"key":"78233","doi-asserted-by":"crossref","unstructured":"Mehrad B, Clark NM, Zhanel GG, Lynch JP 3rd. Antimicrobial resistance in hospital-acquired gram-negative bacterial infections. Chest. 2015 May;147(5):1413\u201321. https:\/\/doi.org\/10.1378\/chest.14-2171<\/a>","DOI":"10.1378\/chest.14-2171"},{"key":"78234","doi-asserted-by":"crossref","unstructured":"Stewardson AJ, Marimuthu K, Sengupta S, Allignol A, El-Bouseary M, Carvalho MJ, et al. Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study. Lancet Infect Dis. 2019 Jun;19(6):601\u201310. https:\/\/doi.org\/10.1016\/S1473-3099(18)30792-8<\/a>","DOI":"10.1016\/S1473-3099(18)30792-8"},{"key":"78235","doi-asserted-by":"crossref","unstructured":"Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, et al.; EPIC II Group of Investigators. International study of the prevalence and outcomes of infection in intensive care units. JAMA. 2009 Dec;302(21):2323\u20139. https:\/\/doi.org\/10.1001\/jama.2009.1754<\/a>","DOI":"10.1001\/jama.2009.1754"},{"key":"78236","doi-asserted-by":"crossref","unstructured":"Roth JA, Hornung-Winter C, Radicke I, Hug BL, Biedert M, Abshagen C, et al. Direct Costs of a Contact Isolation Day: A Prospective Cost Analysis at a Swiss University Hospital. Infect Control Hosp Epidemiol. 2018 Jan;39(1):101\u20133. https:\/\/doi.org\/10.1017\/ice.2017.258<\/a>","DOI":"10.1017\/ice.2017.258"},{"key":"78237","doi-asserted-by":"crossref","unstructured":"Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012 Mar;18(3):268\u201381. https:\/\/doi.org\/10.1111\/j.1469-0691.2011.03570.x<\/a>","DOI":"10.1111\/j.1469-0691.2011.03570.x"},{"key":"78238","doi-asserted-by":"crossref","unstructured":"KRINKO. Anforderungen an die Hygiene bei der Aufbereitung von Medizinprodukten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012 Oct;55(10):1244\u2013310. https:\/\/doi.org\/10.1007\/s00103-012-1548-6<\/a>","DOI":"10.1007\/s00103-012-1548-6"},{"key":"78239","doi-asserted-by":"crossref","unstructured":"Wolfensberger A, Kuster SP, Marchesi M, Zbinden R, Hombach M. The effect of varying multidrug-resistence (MDR) definitions on rates of MDR gram-negative rods. Antimicrob Resist Infect Control. 2019 Nov;8(1):193. https:\/\/doi.org\/10.1186\/s13756-019-0614-3<\/a>","DOI":"10.1186\/s13756-019-0614-3"},{"key":"78240","doi-asserted-by":"crossref","unstructured":"Gasser M, Schrenzel J, Kronenberg A. f\u00fcr das Schweizerische Zentrum f\u00fcr Antibiotikaresistenzen. Aktuelle Entwicklung der Antibiotikaresistenzen in der Schweiz. Swiss Med Forum. 2018;18(46):943-949. https:\/\/doi.org\/https:\/\/doi.org\/10.4414\/smf.2018.03404<\/a>","DOI":"10.4414\/smf.2018.03404"},{"key":"78241","doi-asserted-by":"crossref","unstructured":"Tacconelli E, Buhl M, Humphreys H, Malek V, Presterl E, Rodriguez-Ba\u00f1o J, et al.; EUCIC StopNegative group. Analysis of the challenges in implementing guidelines to prevent the spread of multidrug-resistant gram-negatives in Europe. BMJ Open. 2019 May;9(5):e027683. https:\/\/doi.org\/10.1136\/bmjopen-2018-027683<\/a>","DOI":"10.1136\/bmjopen-2018-027683"},{"key":"78242","doi-asserted-by":"crossref","unstructured":"Ramirez MS, Tolmasky ME. Amikacin: Uses, Resistance, and Prospects for Inhibition. Molecules. 2017 Dec;22(12):E2267. https:\/\/doi.org\/10.3390\/molecules22122267<\/a>","DOI":"10.3390\/molecules22122267"},{"key":"78243","doi-asserted-by":"crossref","unstructured":"Van Looveren M, Goossens H, Group AS ; ARPAC Steering Group. Antimicrobial resistance of Acinetobacter spp. in Europe. Clin Microbiol Infect. 2004 Aug;10(8):684\u2013704. https:\/\/doi.org\/10.1111\/j.1469-0691.2004.00942.x<\/a>","DOI":"10.1111\/j.1469-0691.2004.00942.x"},{"key":"78244","doi-asserted-by":"crossref","unstructured":"Nowak J, Zander E, Stefanik D, Higgins PG, Roca I, Vila J, et al.; MagicBullet Working Group WP4. High incidence of pandrug-resistant Acinetobacter baumannii isolates collected from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. J Antimicrob Chemother. 2017 Dec;72(12):3277\u201382. https:\/\/doi.org\/10.1093\/jac\/dkx322<\/a>","DOI":"10.1093\/jac\/dkx322"},{"key":"78245","doi-asserted-by":"crossref","unstructured":"Ekkelenkamp MB, Cant\u00f3n R, D\u00edez-Aguilar M, Tunney MM, Gilpin DF, Bernardini F, et al. Susceptibility of Pseudomonas aeruginosa Recovered from Cystic Fibrosis Patients to Murepavadin and 13 Comparator Antibiotics. Antimicrob Agents Chemother. 2020 Jan;64(2):e01541-19. https:\/\/doi.org\/10.1128\/AAC.01541-19<\/a>","DOI":"10.1128\/AAC.01541-19"},{"key":"78246","unstructured":"The European Committee on Antimicrobial Susceptibility. 2021, Testing.https:\/\/www.eucast.org\/fileadmin\/src\/media\/PDFs\/EUCAST_files\/Expert_Rules\/2021\/Intrinsic_Resistance_and_Unusual_Phenotypes_Tables_v3.3_20211018.pdf"},{"key":"78247","doi-asserted-by":"crossref","unstructured":"Lutgring JD, Limbago BM. The Problem of Carbapenemase-Producing-Carbapenem-Resistant-Enterobacteriaceae Detection. J Clin Microbiol. 2016 Mar;54(3):529\u201334. https:\/\/doi.org\/10.1128\/JCM.02771-15<\/a>","DOI":"10.1128\/JCM.02771-15"},{"key":"78248","unstructured":"NARA, The National Reference Center for Emerging Antibiotic Resistance, unifr.ch\/med\/nara\/ (Accessed 11 Jan. 2022)."},{"key":"78249","doi-asserted-by":"crossref","unstructured":"Heinemann B, Wisplinghoff H, Edmond M, Seifert H. 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