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Variation in Definitions and Isolation Procedures for Multidrug-Resistant Gram-Negative Bacteria: A Survey of the Society for Healthcare Epidemiology of America Research Network

Part of: SHEA Research Network Collection

Published online by Cambridge University Press:  10 May 2016

Marci Drees ,
Lisa Pineles ,
Anthony D. Harris  and
Daniel J. Morgan
Marci Drees*
Affiliation:
Department of Medicine, Christiana Care Health System, Wilmington, Delaware; and Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
Lisa Pineles
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland
Daniel J. Morgan
Affiliation:
University of Maryland School of Medicine, Baltimore, Maryland Veterans Affairs Maryland Healthcare System, Baltimore, Maryland
*
Christiana Care Health System, 4755 Ogletown-Stanton Road, Suite 2E70, PO Box 6001, Newark, DE 19718 (mdrees@christianacare.org)
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Abstract

Objective.

To assess definitions, experience, and infection control practices for multidrug-resistant gram-negative bacteria (MDR-GNB), including Enterobacteriaceae, Acinetobacter, and Pseudomonas species, in acute care hospitals.

Design.

Cross-sectional survey.

Participants.

US and international members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.

Methods.

Online survey that included definitions, infection control procedures, and microbiology capability related to MDR-GNB and other MDR bacteria.

Results.

From November 2012 through February 2013, 66 of 170 SHEA Research Network members responded (39% response rate), representing 26 states and 15 countries. More than 80% of facilities reported experience with each MDR-GNB isolate, and 78% had encountered GNB resistant to all antibiotics except colistin (62% Acinetobacter, 59% Pseudomonas, and 52% Enterobacteriaceae species). Participants varied regarding their definitions of “multidrug resistant,” with 14 unique definitions for Acinetobacter, 18 for Pseudomonas, and 22 for Enterobacteriaceae species. Substantial variation also existed in isolation practices. Although isolation was commonly used for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant Enterobacteriaceae (CRE), approximately 20% of facilities did not isolate for MDR Pseudomonas or Acinetobacter. The majority of those that isolated MDR organisms also removed isolation using a wide variety of criteria.

Conclusion.

Facilities vary significantly in their approach to preventing MDR-GNB transmission. Although practices for MRSA and VRE are relatively standardized, emerging pathogens CRE and other MDR-GNB have highly varied definitions and management. This confusion makes communication difficult, and varied use of isolation may contribute to emergence of these organisms. Public health agencies need to promote standard definitions and management to enable broader initiatives to limit emergence of MDR-GNB.

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. 362 - 366
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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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 health care settings, 2006. Am J Infect Control 2007;35(10 suppl 2):S165–S193.Google Scholar
2. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(10 suppl 2):S65–S164.CrossRefGoogle Scholar
3. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58(10):256–260.Google Scholar
4. Centers for Disease Control and Prevention. 2012 CRE toolkit—guidance for control of carbapenem-resistant Enterobacteriaceae (CRE). http://www.cdc.gov/hai/organisms/cre/cre-toolkit/. Accessed August 20, 2013.Google Scholar
5. Nicasio, AM, Kuti, JL, Nicolau, DP. The current state of multi-drug-resistant gram-negative bacilli in North America. Pharmacotherapy 2008;28(2):235–249.CrossRefGoogle Scholar
6. Jacoby, GA, Munoz-Price, LS. The new β-lactamases. N Engl J Med 2005;352(4):380–391.CrossRefGoogle ScholarPubMed
7. Munoz-Price, LS, Weinstein, RA. Acinetobacter infection. N Engl J Med 2008;358(12):1271–1281.Google Scholar
8. Paterson, DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006;34(5 suppl 1):S20–S28.Google Scholar
9. Morgan, DJ, Meddings, J, Saint, S, et al. Does nonpayment for hospital-acquired catheter-associated urinary tract infections lead to overtesting and increased antimicrobial prescribing? Clin Infect Dis 2012;55(7):923–929.CrossRefGoogle ScholarPubMed
10. Lautenbach, E, Saint, S, Henderson, DK, Harris, AD. Initial response of health care institutions to emergence of H1N1 influenza: experiences, obstacles, and perceived future needs. Clin Infect Dis 2010;50(4):523–527.Google Scholar
11. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: Twentieth Informational Supplement. Wayne, PA: Clinical and Laboratory Standards Institute, 2010. CLSI document M100-S23.Google Scholar
12. Magiorakos, AP, Srinivasan, A, Carey, RB, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268–281.CrossRefGoogle ScholarPubMed
13. Robicsek, A, Beaumont, JL, Peterson, LR. Duration of colonization with methicillin-resistant Staphylococcus aureus . Clin Infect Dis 2009;48(7):910–913.CrossRefGoogle ScholarPubMed
14. 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(10):1654–1660.Google Scholar