Hostname: page-component-cb9f654ff-hqlzj Total loading time: 0 Render date: 2025-08-06T16:02:52.764Z Has data issue: false hasContentIssue false
  • English
  • Français

Antimicrobial Proficiency Testing of National Nosocomial Infections Surveillance System Hospital Laboratories

Published online by Cambridge University Press:  02 January 2015

Jeffrey C. Hageman ,
Scott K. Fridkin ,
Jasmine M. Mohammed ,
Christine D. Steward ,
Robert P. Gaynes ,
Fred C. Tenover  and
National Nosocomial Infections Surveillance (NNIS) System Hospitals
Jeffrey C. Hageman*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Scott K. Fridkin
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jasmine M. Mohammed
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Christine D. Steward
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Gaynes
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Fred C. Tenover
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, MS A-35, Centers for Disease Control and Prevention, 1600 Clifton Rd., Atlanta, GA 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The National Nosocomial Infections Surveillance (NNIS) System personnel report trends in antimicrobial-resistant pathogens. To validate select antimicrobial susceptibility testing results and to identify test methods that tend to produce errors, we conducted proficiency testing among NNIS System hospital laboratories.

Setting:

NNIS System hospital laboratories in the United States.

Methods:

Each laboratory received five organisms (ie, an imipenem-resistant Serratia marcescens, an oxacillin-resistant Staphylococcus aureus, a vancomycin-resistant Enterococcus faecalis, a vancomycin-intermediate Staphylococcus epidermidis, and an extended-spectrum beta-lactamase (ESβL)-producing Klebsiella pneumoniae). Testing results were compared with reference testing results from the Centers for Disease Control and Prevention.

Results:

Of 138 laboratories testing imipenem against the Serratia marcescens strain, 110 (80%) correctly reported minimum inhibitory concentrations (MICs) or zone sizes in the resistant range. All 193 participating laboratories correctly reported the Staphylococcus aureus strain as oxacillin resistant. Of the 193 laboratories, 169 (88%) reported correct MICs or zone sizes for the vancomycin-resistant Enterococcus faecalis. One hundred sixty-two (84%) of 193 laboratories demonstrated the ability to detect a vancomycin-intermediate strain of Staphylococcus epidermidis; however, disk diffusion performed poorly when testing both staphylococci and enterococci with vancomycin. Although laboratory personnel correctly reported nonsusceptible extended-spectrum cephalosporins and aztreonam results for K. pneumoniae, only 98 (51%) of 193 correctly reported this organism as an ESβL producer.

Conclusion:

Overall, NNIS System hospital laboratory personnel detected most emerging resistance patterns. Disk diffusion continues to be unreliable for vancomycin testing of staphylococci and must be used cautiously for enterococci. Further education on the processing of ESβL-producing organisms is warranted.

Information

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 5 , May 2003 , pp. 356 - 361
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Schwartz, B, Bell, D, Hughes, JM. Preventing the emergence of antimicrobial resistance: a call for action by clinicians, public health officials, and patients. JAMA 1997;278:944–945.Google Scholar
2.McGowan, JE, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997;11:297–311.Google Scholar
3.Tenover, FC, Tokars, J, Swenson, J, Paul, S, Spitalny, K, Jarvis, WR. Ability of clinical laboratories to detect antimicrobial agent-resistant enterococci. J Clin Microbiol 1993;31:1695–1699.Google Scholar
4.Tenover, FC, Lancaster, MV, Hill, BC, et al.Characterization of staphylococci with reduced susceptibilities to vancomycin and other gly-copeptides. J Clin Microbiol 1998;36:1020–1027.Google Scholar
5.Tenover, FC, Swenson, JM, O'Hara, CM, Stocker, SA. Ability of commercial and reference antimicrobial susceptibility testing methods to detect vancomycin resistance in enterococci. J Clin Microbiol 1995;33:1524–1527.Google Scholar
6.Tenover, FC, Mohammed, MJ, Stelling, J, O'Brien, T, Williams, R. Ability of laboratories to detect emerging antimicrobial resistance: proficiency testing and quality control results from the World Health Organization's external quality assurance system for antimicrobial susceptibility testing. J Clin Microbiol 2001;39:241–250.Google Scholar
7.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 2000;28:429–448.CrossRefGoogle Scholar
8.Fridkin, SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001;29:N64–N68.CrossRefGoogle ScholarPubMed
9.Centers for Disease Control and Prevention. Laboratory capacity to detect antimicrobial resistance, 1998. MMWR 2001;48:1167–1171.Google Scholar
10.Tenover, FC, Mohammed, MJ, Gorton, TS, Dembek, ZF. Detection and reporting of organisms producing extended-spectrum beta-lacta-mases: survey of laboratories in Connecticut. J Clin Microbiol 1999;37:4065–4070.Google Scholar
11.Steward, CD, Wallace, D, Hubert, SK, et al.Ability of laboratories to detect emerging antimicrobial resistance in nosocomial pathogens: a survey of Project ICARE laboratories. Diagn Microbiol Infed Dis 2000;38:59–67Google Scholar
12.Deikema, DJ, Pfaller, MASmayevsky, J, et al.Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific Region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001;32:S114–S132.Google Scholar
13.Sahm, DF, Marsilio, MK, Piazza, G. Antimicrobial resistance in key bloodstream bacterial isolates: electronic surveillance with the Surveillance Network Database-USA Clin Infect Dis 1999;29:259–263.Google Scholar
14.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239–244.Google Scholar
15.Swenson, JM, Clark, NC, Sahm, DF, et al.Molecular characterization and multilaboratory evaluation of Enterococcus faecalis ATCC 51299 for quality control of screening tests for vancomycin and high-level aminoglycoside resistance in enterococci. J Clin Microbiol 1995;33:3019–3021.Google Scholar
16.Rosenberg, J, Tenover, FC, Wong, J, Jarvis, W, Vugia, DJ. Are clinical laboratories in California accurately reporting vancomycin-resistant enterococci? J Clin Microbiol 1997;35:2526–2530.CrossRefGoogle ScholarPubMed
17.Yigit, H, Steward, CD, Biddle, JW, Tenover, FC. Characterization of β-lac-tamases and porin changes in carbapenem-resistant isolates of Klebsiella pneumoniae and Serratia marcescens. Presented at the 99th General Meeting of the American Society for Microbiology; May 30-June 3, 1999; Washington, DC. Abstract A-61.Google Scholar
18.Garrett, DO, Jochimsen, E, Murfitt, K, et al.The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis. Infect Control Hosp Epidemiol 1999;20:167–170.Google Scholar
19.Rasheed, JK, Tenover, FC, Anderson, GJ, et al.Characterization of extended-spectrum beta-lactamase reference strain, Klebsiella pneumoniae K6 (ATCC 700603), which produces the novel enzyme SHV-18. Antimicrob Agents Chemother 2000;44:2382–2388.Google Scholar
20.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 4th ed. Wayne, PANational Committee for Clinical Laboratory Standards; 1997. Approved standard M7-A4.Google Scholar
21.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, 6th ed. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M2-A6.Google Scholar
22.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999. Approved standard M100-S9.Google Scholar
23.Richards, C, Emori, TG, Edwards, J, et al.Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. Am J Infect Control 2001;29:400–403.Google Scholar
24.Jones, RN. Method preferences and test accuracy of antimicrobial susceptibility testing. Arch Pathol Lab Med 2001;125:1285–1289.Google Scholar
25.Smith, TL, Pearson, ML, Wilcox, KR, et al.Emergence of vancomycin resistance in Staphylococcus aureus: Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med 1999;340:493–501.Google Scholar
26.Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin: Illinois, 1999. MMWR 2000;48:1165–1167.Google Scholar
27.Hageman, JC, Pegues, DAJepson, C, et al.Vancomycin-intermediate Staphylococcus aureus in a home healthcare patient. Emerg Infect Dis 2001;7:1023–1025.CrossRefGoogle Scholar
28.Fridkin, SKVancomycin-intermediate and -resistant Staphylococcus aureus: what the infectious diseases specialist needs to know. Clin Infect Dis 2001;32:108–115.Google Scholar
29.Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR 1997;46:626-628, 635.Google Scholar
30.Tenover, FC, Biddle, JW, Lancaster, MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerg Infect Dis 2001;7:327–332.Google Scholar
31.Marlowe, EM, Cohen, MD, Hindler, JF, Ward, KW, Bruckner, DAPractical strategies for detecting and confirming vancomycin-intermediate Staphylococcus aureus: a tertiary-care hospital laboratory's experience. J Clin Microbiol 2001;39:2637–2639.Google Scholar
32.Fridkin, SK, Gaynes, RP. Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303–316.Google Scholar
33.Grist, R. External factors affecting imipenem performance in dried microdilution MIC plates. J Clin Microbiol 1992;30:535–536.Google Scholar
34.White, RL, Kays, MB, Friedrich, LV, Brown, EW, Koonce, JR. Pseudoresistance of Pseudomonas aeruginosa resulting from degradation of imipenem in an automated susceptibility testing system with predried panels. J Clin Microbiol 1991;29:398–400.Google Scholar
35.Carmeli, Y, Eichelberger, K, Soja, D, et al.Failure of quality control measures to prevent reporting of false resistance to imipenem, resulting in a pseudo-outbreak of imipenem-resistant Pseudomonas aeruginosa. J Clin Microbiol 1998;36:595–597.Google Scholar
36.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1998. Approved standard M100-S8.Google Scholar