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Are we well prepared for possible cross-border outbreaks of resistant bacteria?

Published: 15th July 2019 Last updated: 19th July 2019

The spread of resistant bacteria may pose a serious threat to public health within and between countries. It is vital that potential outbreaks are responded to quickly and effectively in cross-border cooperation and through the integration of networks of healthcare institutions and professionals. A test, in which Dutch and German healthcare professionals were questioned on an outbreak scenario, shows that there is a good basis for cooperation, but that there is still room for improvement in terms of cross-border coordination, working relationships and trust in the networks.

The research, published under the auspices of the National Institute for Public Health and the Environment (RIVM), was recently published in PLOS One and is partly based on Jacklien Maessen's master thesis, which she wrote for her Research Master Social and Behavioral Sciences at Tilburg University, supervised by Jörg Raab (Organization Studies). The article is titled: How prepared are we for cross-border outbreaks? An exploratory analysis of cross-border response networks for outbreaks of multidrug resistant micro-organisms in the Netherlands and Germany. PLOS One (Public Library of Science one) is an internationally reviewed scientific journal based on open access.


Quantitative methods were used to explore response networks during a cross-border outbreak of carbapenem resistant Enterobacteriaceae in healthcare settings. Eighty-six Dutch and German health professionals reflected on a fictive but realistic outbreak scenario (response rate ≈ 70%). Data were collected regarding collaborative relationships between stakeholders during outbreak response, prior working relationships, and trust in the networks. Network analysis techniques were used to analyze the networks on the network level (density, centralization, clique structures, and similarity of tie constellations between two networks) and node level (brokerage measures and degree centrality).


Although stakeholders mainly collaborate with stakeholders belonging to the same country, transnational collaboration is present in a centralized manner. Integration of the network is reached, since several actors are beneficially positioned to coordinate transnational collaboration. However, levels of trust are moderately low and prior-existing cross-border working relationships are sparse.

Given the explored network characteristics, we conclude that the system has a promising basis to achieve effective coordination. However, future research has to determine what kind of network governance form might be most effective and efficient in coordinating the necessary cross-border response activity. Furthermore, networks identified in this study are not only crucial in times of outbreak containment, but should also be fostered in times of non-crisis

*Multidrug resistant microorganisms (MDROs) against several groups of antibiotics are becoming increasingly common. The excessive and inappropriate use of antibiotics has made some bacteria insensitive to them. In that case, it is necessary to switch to reserve drugs, against which there is a risk of increasing resistance. The spread of MDROs pose a serious threat to healthcare institutions. Patients have to stay longer in hospitals, with possibly poorer prognosis. Costs are rising sharply and hospitalisation stops are also possible.