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  • EpideMiology and control measures of outBreaks due to Antibiotic-Resistant orGanisms in EurOpe (EMBARGO): a systematic review protocol

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Public health
Protocol
EpideMiology and control measures of outBreaks due to Antibiotic-Resistant orGanisms in EurOpe (EMBARGO): a systematic review protocol
  1. Babu Rajendran Nithya1,
  2. Beryl Primrose Gladstone1,
  3. Jesús Rodríguez-Baño2,
  4. Frangiscos Sifakis3,
  5. Andreas Voss4,5,
  6. Yehuda Carmeli6,
  7. Francesco Robert Burkert1,
  8. Panagiota Gkolia1,
  9. Evelina Tacconelli1
  1. 1Division of Infectious Diseases, Department of Internal Medicine 1, DZIF Partner Centre, University Hospital Tuebingen, Tuebingen, Germany
  2. 2Department of Infectious Diseases and Clinical Microbiology, Hospital Universitario Virgen Macarena, Servicio Andaluz de Salud, Sevilla, Spain
  3. 3AstraZeneca, Gaithersburg, Maryland, USA
  4. 4Department of Clinical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
  5. 5Department of Medical Microbiology, Radboud University Medical Center Nijmegen, The Netherlands
  6. 6National Center for Antibiotic Resistance and Infection Control, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
  1. Correspondence to Professor Evelina Tacconelli; Evelina.Tacconelli{at}med.uni-tuebingen.de

Abstract

Introduction Improving our understanding of outbreaks due to antibiotic-resistant bacteria (ARB) and their control is critical in the current public health scenario. The threat of outbreaks due to ARB requires multifaceted efforts. However, a global overview of epidemiological characteristics of outbreaks due to ARB and effective infection control measures is missing. In this paper, we describe the protocol of a systematic review aimed at mapping and characterising the epidemiological aspects of outbreaks due to ARB and infection control measures in European countries.

Methods and analysis The databases MEDLINE, Web of Knowledge and Cochrane library will be searched using a 3-step search strategy. Selection of articles for inclusion will be performed by 2 reviewers using predefined eligibility criteria. All study designs will be included if they report an outbreak and define the microbiological methods used for microorganism identification. The target bacteria will be methicillin-resistant and vancomycin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, ceftazidime-resistant and carbapenem-resistant Acinetobacter baumannii, ceftazidime-resistant and carbapenem-resistant Pseudomonas aeruginosa, ciprofloxacin-resistant Escherichia coli, extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae, carbapenem-resistant and carbapenamase-producing Enterobacteriaceae. Data will be extracted using a tailored pilot tested form and the quality of reporting will be assessed using the ORION (Outbreak Reports and Intervention Studies Of Nosocomial infections) tool. Data will be synthesised and reported by the type of ARB, setting and country. Infection control measures and bundles of measures will be described. The effectiveness will be reported as defined by the authors. Regression analysis will be used to define independent factors associated with outbreaks' control. Heterogeneity between studies will be assessed by forest plots and I² statistics.

Ethics and dissemination Ethical approval is not applicable for this study. Findings will be disseminated through journal publication and conference presentations and talks.

  • outbreak
  • antimicrobial resistance
  • EPIDEMIOLOGY

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2016-013634

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    Footnotes

    • Contributors ET, YC and FS conceptualised the study idea, oversaw the development of the protocol and prepared draft versions of the paper. BPG wrote the protocol and prepared draft versions of the manuscript. AV, JR-B, PG, FRB and NBR critically appraised the protocol and were involved to its development by revising different versions. All authors approved the final version of the protocol and take responsibility for its content.

    • Funding This research project receives support from the Innovative Medicines Initiative Joint Undertaking (IMI JU) under grant agreement numbers 115737 (COMBACTE-MAGNET) and 115618 (DRIVE-AB), resources of which are composed of financial contribution from the European Union Seventh Framework Programme (FP7/2007-2013) and EFPIA companies in kind contribution. In addition as a special form of the IMI JU grant, FS received a direct financial contribution from AstraZeneca.

    • Competing interests FS is an employee of AstraZeneca, an EFPIA (European Federation of Pharmaceutical Industries and Association) member company in the IMI JU and costs related to his research contributions were covered by AstraZeneca as in-kind contribution under the IMI JU agreement.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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