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Querying Automated Antibiotic Susceptibility Testing Instruments: A Novel Population-Based Active Surveillance Method for Multidrug-Resistant Gram-Negative Bacilli

Published online by Cambridge University Press:  10 May 2016

Jessica Reno ,
Calista Schenck ,
Janine Scott ,
Leigh Ann Clark ,
Yun F. (Wayne) Wang ,
Susan Ray ,
Paula Snippes Vagnone  and
Jesse T. Jacob
Jessica Reno
Affiliation:
Atlanta Research and Education Foundation, Decatur, Georgia Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia
Calista Schenck
Affiliation:
Atlanta Research and Education Foundation, Decatur, Georgia Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia
Janine Scott
Affiliation:
Atlanta Research and Education Foundation, Decatur, Georgia Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia
Leigh Ann Clark
Affiliation:
Atlanta Research and Education Foundation, Decatur, Georgia Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia
Yun F. (Wayne) Wang
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Grady Memorial Hospital, Atlanta, Georgia Emory University School of Medicine, Atlanta, Georgia
Susan Ray
Affiliation:
Atlanta Research and Education Foundation, Decatur, Georgia Georgia Emerging Infections Program, Decatur, Georgia Atlanta Veterans Affairs Medical Center, Decatur, Georgia Grady Memorial Hospital, Atlanta, Georgia Emory University School of Medicine, Atlanta, Georgia
Paula Snippes Vagnone
Affiliation:
Minnesota Department of Health, St. Paul, Minnesota
Jesse T. Jacob*
Affiliation:
Georgia Emerging Infections Program, Decatur, Georgia Emory University School of Medicine, Atlanta, Georgia
*
Orr Building 1020, 550 Peachtree Street NE, Atlanta, GA 30308 (jtiacob@emory.edu)
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Abstract

Objective.

To describe the implementation of a population-based surveillance system for multidrug-resistant gram-negative bacilli (MDR-GNB).

Design.

Population-based active surveillance by the Georgia Emerging Infections Program.

Setting.

Metropolitan Atlanta, starting November 2010.

Patients.

Residents with MDR-GNB isolated from urine or a normally sterile site culture.

Methods.

Surveillance was implemented in 3 phases: (1) surveying laboratory antibiotic susceptibility testing practices, (2) piloting surveillance to estimate the proportion of GNB that were MDR, and (3) maintaining ongoing active surveillance for carbapenem-nonsusceptible Enterobacteriaceae and Acinetobacter baumannii using the 2010 Clinical and Laboratory Standards Institute (CLSI) breakpoints. Pilot surveillance required developing and installing queries for GNB on the 3 types of automated testing instruments (ATIs), such as MicroScan, in Atlanta's clinical laboratories. Ongoing surveillance included establishing a process to extract data from ATIs consistently, review charts, manage data, and provide feedback to laboratories.

Results.

Output from laboratory information systems typically used for surveillance would not reliably capture the CLSI breakpoints, but queries developed for the 3 ATIs did. In November 2010, 0.9% of Enterobacteriaceae isolates and 35.7% of A. baumannii isolates from 21 laboratories were carbapenem nonsusceptible. Over a 5-month period, 82 Enterobacteriaceae and 59 A. baumannii were identified as carbapenem nonsusceptible.

Conclusions.

Directly querying ATIs, a novel method of active surveillance for MDR-GNB, proved to be a reliable, sustainable, and accurate method that required moderate initial investment and modest maintenance. Ongoing surveillance is critical to assess the burden of and changes in MDR-GNB to inform prevention efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 4: Special Topic Issue: Carbapenem-Resistant Enterobacteriaceae and Multidrug-Resistant Organisms , April 2014 , pp. 336 - 341
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Nordmann, P, Naas, T, Poirel, L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2011;17(10):1791–1798.CrossRefGoogle ScholarPubMed
2. Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42:S82–S89.CrossRefGoogle ScholarPubMed
3. Jacob, JT, Klein, E, Laxminarayan, R, et al. Vital signs: carbapenem-resistant Enterobacteriaceae. MMWR Morb Mortality Wkly Rep 2013;62(9):165–170.Google Scholar
4. Schwaber, MJ, Klarfeld-Lidji, S, Navon-Venezia, S, Schwartz, D, Leavitt, A, Carmeli, Y. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008;52(3):1028–1033.CrossRefGoogle ScholarPubMed
5. Bratu, S, Landman, D, Haag, R, et al. Rapid spread of carbapenem-resistant Klebsiella pneumoniae in New York City. Arch Intern Med 2005;165:1430–1435.CrossRefGoogle ScholarPubMed
6. Gasink, LB, Edelstein, PH, Lautenbach, E, Synnestvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase–producing K. pneumoniae . Infect Control Hosp Epidemiol 2009;30(12):1180–1185.CrossRefGoogle ScholarPubMed
7. Khan, AS, Dancer, SJ, Humphreys, H. Priorities in the prevention and control of multidrug-resistant Enterobacteriaceae in hospitals. J Hosp Infect 2012;82(2):85–93.CrossRefGoogle ScholarPubMed
8. Higgins, PG, Dammhayn, C, Hackel, M, Seifert, H. Global spread of carbapenem-resistant Acinetobacter baumannii . J Antimicrob Chemother 2010;65(2):233–238.CrossRefGoogle ScholarPubMed
9. Karageorgopoulos, DE, Falagas, ME. Current control and treatment of multidrug-resistant Acinetobacter baumannii infections. Lancet Infect Dis 2008;8(12):751–762.CrossRefGoogle ScholarPubMed
10. Sunenshine, RH, Wright, M-O, Maragakis, LL, et al. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 2007;13(1):97–103.CrossRefGoogle ScholarPubMed
11. Castanheira, M, Farrell, SE, Deshpande, LM, Mendes, RE, Jones, RN. Prevalence of β-lactamase-encoding genes among Entero-bacteriaceae bacteremia isolates collected in 26 US hospitals: report from the SENTRY Antimicrobial Surveillance Program (2010). Antimicrob Agents Chemother 2013;57(7):3012–3020.CrossRefGoogle Scholar
12. Deshpande, LM, Rhomberg, PR, Sader, HS, Jones, RN. Emergence of serine carbapenemases (KPC and SME) among clinical strains of Enterobacteriaceae isolated in the United States medical centers: report from the MYSTIC Program (1999–2005). Diagn Microbiol Infect Dis 2006;56(4):367–372.CrossRefGoogle ScholarPubMed
13. American FactFinder, US Census Bureau website. Annual estimates of the resident population: April 1, 2010, to July 1, 2012; generated by Jessica Reno using American FactFinder, http://factfinder2.census.gov, May 8, 2013.Google Scholar
14. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. Wayne, PA: CLSI, 2010. CLSI documents M100-S20 and M100-S20-U.Google Scholar
15. Giske, CG, Monnet, DL, Cars, O, Carmeli, Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008;52(3):813–821.CrossRefGoogle ScholarPubMed
16. Orsi, GB, Falcone, M, Venditti, M. Surveillance and management of multidrug-resistant microorganisms. Expert Rev Anti Infect Ther 2011;9(8):653–679.CrossRefGoogle ScholarPubMed
17. Ben-David, D, Kordevani, R, Keller, N, et al. Outcome of carbapenem resistant Klebsiella pneumoniae bloodstream infections. Clin Microbiol Infect 2012;18(1):54–60.CrossRefGoogle ScholarPubMed
18. Patel, G, Huprikar, S, Factor, SH, Jenkins, SG, Calfee, DP. Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol 2008;29(12):1099–1106.CrossRefGoogle ScholarPubMed
19. Borer, A, Saidel-Odes, L, Riesenberg, K, et al. Attributable mortality rate for carbapenem-resistant Klebsiella pneumoniae bacteremia. Infect Control Hosp Epidemiol 2009;30(10):972–976.CrossRefGoogle ScholarPubMed
20. Nguyen, M, Eschenauer, GA, Bryan, M, et al. Carbapenem-resistant Klebsiella pneumoniae bacteremia: factors correlated with clinical and microbiologic outcomes. Diagn Microbiol Infect Dis 2010;67(2):180–184.CrossRefGoogle ScholarPubMed
21. Hombach, M, Wolfensberger, A, Kuster, SP, Bottger, EC. Influence of clinical breakpoint changes from CLSI 2009 to EUCAST 2011 antimicrobial susceptibility testing guidelines on multidrug resistance rates of gram-negative rods. J Clin Microbiol 2013;51(7):2385–2387.CrossRefGoogle ScholarPubMed
22. Hombach, M, Bloemberg, GV, Bottger, EC. Effects of clinical breakpoint changes in CLSI guidelines 2010/2011 and EUCAST guide-lines 2011 on antibiotic susceptibility test reporting of gram-negative bacilli. J Antimicrob Chemother 2012;67(3):622–632.CrossRefGoogle Scholar
23. Tamma, PD, Wu, H, Gerber, JS, et al. Outcomes of children with Enterobacteriaceae bacteremia with reduced susceptibility to ceftriaxone: do the revised breakpoints translate to improved patient outcomes? Pediatr Infect Dis J 2013;32(9):965–969.CrossRefGoogle ScholarPubMed
24. European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters 2013, version 3.1. http://www.eucast.org. Accessed August 16, 2013.Google Scholar