Risk Factors and Transmission of Healthcare-Related Pathogens

The literature reviews and observational studies in this thesis are about the role of epidemiology in describing, identifying and controlling transmission of healthcare-related pathogens. The ultimate goal of conducting these studies is to optimize care and to provide safer care for patients admitted to the Erasmus MC.
In chapter 2 three literature reviews are described about (i) ESBL-producing Klebsiella species, (ii) carbapenem-producing Enterobacteriaceae and (iii) VIM-positive Pseudomonas aeruginosa. The most important risk factors, effective infection prevention strategies and sources have been identified.
In chapter 3 the theoretical knowledge from the systematic reviews has been applied in different outbreak scenarios in the Erasmus MC.
(i) A case-control study on a long-lasting outbreak of VIM-positive P. aeruginosa.
(ii) A nationwide study about contamination of duodenoscopes; following an outbreak report on a duodenoscope as source of VIM-positive P. aeruginosa published by Verfaillie et al. (Endoscopy 2015, 47:493-502)
(iii) An outbreak investigation of a Clostridium difficile outbreak at a gastro-intestinal surgical ward.
Finally, in chapter 4 the role of epidemiology when using genotypic and phenotypic typing techniques is described, (i) for ESBL-producing Klebsiella species, and (ii) for ESBL-producing Escherichia coli.