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Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper

Published online by Cambridge University Press:  02 January 2015

Adam L. Cohen ,
David Calfee ,
Scott K. Fridkin ,
Susan S. Huang ,
John A. Jernigan ,
Ebbing Lautenbach ,
Shannon Oriola ,
Keith M. Ramsey ,
Cassandra D. Salgado  and
Robert A. Weinstein
...Show all authors
Adam L. Cohen*
Affiliation:
Divisions of Bacterial Diseases, Centers For Disease Control And Prevention, Atlanta, Georgia
David Calfee
Affiliation:
Department of Medicine, Mount Sinai School of Medicine, New York, New York
Scott K. Fridkin
Affiliation:
Healthcare Quality Promotion, Centers For Disease Control And Prevention, Atlanta, Georgia
Susan S. Huang
Affiliation:
Division of Infectious Diseases, University of California Irvine Medical Center, Orange, San Diego, California
Ebbing Lautenbach
Affiliation:
Departments of Medicine and Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania
Shannon Oriola
Affiliation:
Sharp Metropolitan Medical Campus, San Diego, California
Keith M. Ramsey
Affiliation:
Departments of Safety and Infection Control, Pitt County Memorial Hospital, and the Department of Medicine, The Brody School of Medicine at East Carolina University, Greenville, North Carolina
Cassandra D. Salgado
Affiliation:
Medical University of South Carolina, Charleston, South Carolina
Robert A. Weinstein
Affiliation:
Cook County Bureau of Health Services and Rush Medical College, Chicago, Illinois
*
Division of Bacterial Diseases, Centers For Disease Control And Prevention, 1600 Clifton Road, Ms C-23, Atlanta, Ga30333 ([email protected])
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Monitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and practical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of infection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in documenting trends over time within their facility and should not be used for interfacility comparison.

Type
Shea/Hicpac Position Paper
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 10 , October 2008 , pp. 901 - 913
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in healthcare settings, 2006. Available at: http://www.cdc.gov/ncidod/dhqp/pdf/ar/mdroGuideline2006.pdf. 2006. Accessed June 24, 2008.Google Scholar
2.Paterson, DL. The epidemiological profile of infections with multidrug-resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43 Suppl 2:S43–48.CrossRefGoogle ScholarPubMed
3.Harris, AD, McGregor, JC, Furuno, JP. What infection control interventions should be undertaken to control multidrug-resistant gram-negative bacteria? Clin Infect Dis 2006;43 Suppl 2:S57–61.CrossRefGoogle ScholarPubMed
4.Jones, RN. Global epidemiology of antimicrobial resistance among community-acquired and nosocomial pathogens: a five-year summary from the SENTRY Antimicrobial Surveillance Program (1997-2001). Semin Respir Crit Care Med 2003;24:121–134.CrossRefGoogle ScholarPubMed
5.Falagas, ME, Koletsi, PK, Bliziotis, IA. The diversity of definitions of multidrug-resistant (MDR) and pandrug-resistant (PDR) Acinetobacter bau-mannii and Pseudomonas aeruginosa. J Med Microbiol 2006;55:1619–1629.Google Scholar
6.McDonald, LC, Coignard, B, Dubberke, E, Song, X, Horan, T, Kutty, PK. Recommendations for surveillance of Clostridium difficile-associated disease. Infect Control Hosp Epidemiol 2007;28:140–145.CrossRefGoogle ScholarPubMed
7.National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
8.Yokoe, DS, Noskin, GA, Cunnigham, SM, et al.Enhanced identification of postoperative infections among inpatients. Emerg Infect Dis 2004;10:1924–1930.CrossRefGoogle ScholarPubMed
9.Trick, WE, Zagorski, BM, Tokars, JI, et al.Computer algorithms to detect bloodstream infections. Emerg Infect Dis 2004;10:1612–1620.CrossRefGoogle ScholarPubMed
10.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
11.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298:1763–1771.CrossRefGoogle ScholarPubMed
12.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.CrossRefGoogle ScholarPubMed
13.Huang, SS, Piatt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.CrossRefGoogle ScholarPubMed
14.Pacio, GA, Visintainer, P, Maguire, G, Wormser, GP, Raffalli, J, Montecalvo, MA. Natural history of colonization with vancomycin-resistant entero-cocci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilli among long-term-care facility residents. Infect Control Hosp Epidemiol 2003;24:246–250.CrossRefGoogle Scholar
15.Byers, KE, Anglim, AM, Anneski, CJ, Farr, BM. Duration of colonization with vancomycin-resistant Enterococcus. Infect Control Hosp Epidemiol 2002;23:207–211.CrossRefGoogle ScholarPubMed
16.Baden, LR, Thiemke, W, Skolnik, A, et al.Prolonged colonization with vancomycin-resistant Enterococcus faecium in long-term care patients and the significance of “clearance.” Clin Infect Dis 2001;33:1654–1660.CrossRefGoogle ScholarPubMed
17.Hindler, JF, Stelling, J. Analysis and presentation of cumulative antibio-grams: a new consensus guideline from the Clinical and Laboratory Standards Institute. Clin Infect Dis 2007;44:867–873.CrossRefGoogle ScholarPubMed
18.White, RL, Friedrich, LV, Burgess, DS, Brown, EW, Scott, LE. Effect of removal of duplicate isolates on cumulative susceptibility reports. Diagn Microbiol Infect Dis 2001;39:251–256.Google Scholar
19.Horvat, RT, Klutman, NE, Lacy, MK, Grauer, D, Wilson, M. Effect of duplicate isolates of methicillin-susceptible and methicillin-resistant Staphylococcus aureus on antibiogram data. J Clin Microbiol 2003;41:4611–4616.CrossRefGoogle ScholarPubMed
20.Lee, SO, Cho, YK, Kim, SY, Lee, ES, Park, SY, Seo, YH. Comparison of trends of resistance rates over 3 years calculated from results for all isolates and for the first isolate of a given species from a patient. J Clin Microbiol 2004;42:4776–4779.CrossRefGoogle ScholarPubMed
21.Lucet, JC, Grenet, K, Armand-Lefevre, L, et al.High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005;26:121–126.CrossRefGoogle ScholarPubMed
22.Furuno, JP, McGregor, JC, Harris, AD, et al.Identifying groups at high risk for carriage of antibiotic-resistant bacteria. Arch Intern Med 2006;166:580–585.CrossRefGoogle ScholarPubMed
23.Binkley, S, Fishman, NO, LaRosa, LA, et al.Comparison of unit-specific and hospital-wide antibiograms: potential implications for selection of empirical antimicrobial therapy. Infect Control Hosp Epidemiol 2006;27:682–687.CrossRefGoogle ScholarPubMed
24.Huang, SS, Rifas-Shiman, SL, Pottinger, JM, et al.Improving the assessment of vancomycin-resistant enterococci by routine screening. J Infect Dis 2007;195:339–346.CrossRefGoogle ScholarPubMed
25.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al.Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330–338.CrossRefGoogle ScholarPubMed
26.2005 AHA Annual Survey. Health Forum, L.L.C. Available at: http://www.vtexplor.org/Downloads/. Accessed September 2, 2008.Google Scholar
27.Salgado, CD, Farr, BM. What proportion of hospital patients colonized with methicillin-resistant Staphylococcus aureus are identified by clinical microbiological cultures? Infect Control Hosp Epidemiol 2006;27:116–121.CrossRefGoogle ScholarPubMed
28.Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188.CrossRefGoogle Scholar
29.Eveillard, M, Lancien, E, Barnaud, G, et al.Impact of screening for MRSA carriers at hospital admission on risk-adjusted indicators according to the imported MRSA colonization pressure. J Hosp Infect 2005;59:254–258.CrossRefGoogle Scholar
30.Diekema, DJ, Edmond, MB. Look before you leap: active surveillance for multidrug-resistant organisms. Clin Infect Dis 2007;44:1101–1107.Google ScholarPubMed
31.Mertz, D, Frei, R, Jaussi, B, et al.Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 2007;45:475–477.CrossRefGoogle ScholarPubMed
32.D'Agata, EM, Gautam, S, Green, WK, Tang, YW. High rate of false-negative results of the rectal swab culture method in detection of gastrointestinal colonization with vancomycin-resistant enterococci. Clin Infect Dis 2002;34:167–172.CrossRefGoogle ScholarPubMed
33.Lautenbach, E, Harris, AD, Perencevich, EN, Nachamkin, I, Tolomeo, P, Metlay, JP. Test characteristics of perirectal and rectal swab compared to stool sample for detection of fluoroquinolone-resistant Escherichia coli in the gastrointestinal tract. Antimicrob Agents Chemother 2005;49:798–800.Google Scholar
34.Marchaim, D, Navon-Venezia, S, Schwartz, D, et al.Surveillance cultures and duration of carriage of multidrug-resistant Acinetobacter baumannii. J Clin Microbiol 2007;45:1551–1555.CrossRefGoogle ScholarPubMed
35.Robicsek, A, Beaumont, JL, Paule, SM, et al.Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148:409–418.CrossRefGoogle ScholarPubMed
36.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.CrossRefGoogle ScholarPubMed
37.Clinical and Laboratory Standards Institute (CLSI). Analysis and presentation of cumulative antimicrobial susceptibility test data: approved guideline. 2nd ed. Vol. 25. No. 28. Wayne, PA: CLSI, 2005:M39–A2.Google Scholar
38.Fridkin, SK, Edwards, JR, Tenover, FC, Gaynes, RP, McGowan, JE Jr. Antimicrobial resistance prevalence rates in hospital antibiograms reflect prevalence rates among pathogens associated with hospital-acquired infections. Clin Infect Dis 2001;33:324–330.CrossRefGoogle ScholarPubMed
39.Bantar, C, Alcazar, G, Franco, D, et al.Are laboratory-based antibiograms reliable to guide the selection of empirical antimicrobial treatment in patients with hospital-acquired infections? J Antimicrob Chemother 2007;59:140–143.CrossRefGoogle ScholarPubMed
40.Pakyz, AL. The utility of hospital antibiograms as tools for guiding empiric therapy and tracking resistance. Insights from the Society of Infectious Diseases Pharmacists. Pharmacotherapy 2007;27:1306–1312.Google Scholar
41.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al.Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.Google Scholar
42.Shitrit, P, Gottesman, BS, Katzir, M, Kilman, A, Ben-Nissan, Y, Chowers, M. Active surveillance for methicillin-resistant Staphylococcus aureus (MRSA) decreases the incidence of MRSA bacteremia. Infect Control Hosp Epidemiol 2006;27:1004–1008.CrossRefGoogle ScholarPubMed
43.Price, CS, Paule, S, Noskin, GA, Peterson, LR. Active surveillance reduces the incidence of vancomycin-resistant enterococcal bacteremia. Clin Infect Dis 2003;37:921–928.CrossRefGoogle ScholarPubMed
44.Fowler, VG Jr, Boucher, HW, Corey, GR, et al.Daptomycin versus standard therapy for bacteremia and endocarditis caused by Staphylococcus aureus. N Engl J Med 2006;355:653–665.CrossRefGoogle ScholarPubMed
45.Erbay, A, Ergonul, O, Stoddard, GJ, Samore, MH. Recurrent catheter-related bloodstream infections: risk factors and outcome. Int J Infect Dis 2006;10:396–400.Google Scholar
46.Fowler, VG Jr, Sakoulas, G, Mclntyre, LM, et al.Persistent bacteremia due to methicillin-resistant Staphylococcus aureus infection is associated with agr dysfunction and low-level in vitro resistance to thrombin-induced platelet microbicidal protein. J Infect Dis 2004;190:1140–1149.CrossRefGoogle ScholarPubMed
47.Health Protection Agency. Surveillance of Healthcare Associated Infections Report 2007. Available at: http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPAweb_C/1196942166935?p= 1158945066450. Accessed June 24, 2008.Google Scholar
48.Merrer, J, Santoli, F, Appere de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718–723.CrossRefGoogle Scholar
49.Bonten, MJ, Slaughter, S, Ambergen, AW, et al.The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158:1127–1132.Google Scholar
50.Weinstein, RA, Kabins, SA. Strategies for prevention and control of multiple drug-resistant nosocomial infection. Am J Med 1981;70:449–454.CrossRefGoogle ScholarPubMed
51.Ostrowsky, BE, Trick, WE, Sohn, AH, et al.Control of vancomycin-resistant Enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.CrossRefGoogle ScholarPubMed
52.Rhame, FS, Sudderth, WD. Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. Am J Epidemiol 1981;113:1–11.Google Scholar
53.Berthelot, P, Gamier, M, Fascia, P, et al.Conversion of prevalence survey data on nosocomial infections to incidence estimates: a simplified tool for surveillance? Infect Control Hosp Epidemiol 2007;28:633–636.Google Scholar
54.Gastmeier, P, Brauer, H, Sohr, D, et al.Converting incidence and prevalence data of nosocomial infections: results from eight hospitals. Infect Control Hosp Epidemiol 2001;22:31–34.CrossRefGoogle ScholarPubMed
55.Harris, AD, Kotetishvili, M, Shurland, S, et al.How important is patient-to-patient transmission in extended-spectrum beta-lactamase Escherichia coli acquisition. Am J Infect Control 2007;35:97–101.Google Scholar
56.Flynn, DM, Weinstein, RA, Nathan, C, Gaston, MA, Kabins, SA. Patients' endogenous flora as the source of “nosocomial” Enterobacter in cardiac surgery. J Infect Dis 1987;156:363–368.Google Scholar
57.Institute for Healthcare Improvement. Institute for Healthcare Improvement. How-to guide: reduce methicillin-resistant Staphylococcus aureus (MRSA) infection, 2006. Available at: http://www.ihi.org/IHI/Programs/Campaign/MRSAInfection.htm. Accessed June 24, 2008.Google Scholar
58.Curran, ET, Benneyan, JC, Hood, J. Controlling methicillin-resistant Staphylococcus aureus: a feedback approach using annotated statistical process control charts. Infect Control Hosp Epidemiol 2002;23:13–18.CrossRefGoogle ScholarPubMed
59.Calfee, D, Salgado, CD. Detection and prevention of methicillin-resistant Staphylococcus aureus (MRSA) in acute care hospitals. Infect Control Hosp Epidemiol 2008, in press.Google Scholar
60.Association for Professionals in Infection Control and Epidemiology (APIC). Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings. Washington, DC: APIC; March 2007.Google Scholar
61.Chaberny, IF, Sohr, D, Ruden, H, Gastmeier, P. Development of a surveillance system for methicillin-resistant Staphylococcus aureusin German hospitals. Infect Control Hosp Epidemiol 2007;28:446–452.Google Scholar