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

Abstract

EXECUTIVE SUMMARYMonitoring 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 prac tical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of in fection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in docu menting trends over time within their facility and should not be used for interfacility comparison.The following MDROs are addressed: (1) methicillin-re sistant Staphylococcus aureus; (2) vancomycin-resistant En terococcus species; (3) multidrug-resistant gram-negative ba cilli; and (4) vancomycin-resistant S. aureus. We convened a working group of experts that reviewed current practices, the peer-reviewed literature, and existing guidelines on surveil lance strategies and key metrics.We propose that healthcare facilities use the following 4 routine metrics to monitor MDROs and the infections they cause: (1) an MORO-specific line list for tracking patients who have acquired an MDRO; (2) an antibiogram for mon itoring susceptibility patterns of isolates recovered from pa tients; (3) the incidence of hospital-onset MDRO bacteremia, which is an objective, laboratory-based metric that is highly associated with invasive disease and does not require chart review to estimate infection burden; and ( 4) clinical culture results, to measure incidence of infection or colonization, to quantify the number of people whose MORO acquisition is healthcare associated. In addition, healthcare facilities may want to calculate both the overall prevalence of carriage and the prevalence of carriage at admission, the latter of which can be useful in detecting importation of methicillin-resistant S. aureus into healthcare facilities, to estimate the exposure burden. Active surveillance testing can augment and increase the accuracy of some metrics. Healthcare facilities not per forming active surveillance testing might wish to consider point-prevalence screening, to help assess how much the number of positive clinical culture results underestimates the hidden reservoir of MDROs. It is important to understand the limitations of all proxy metrics. Because of the paucity of published research findings focused on this area of study, most recommendations were based on opinion and were heavily influenced by the perceived usefulness and simplicity of the metric for assessing MDROs in the hospital setting and for determining the impact of interventions.

Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities

“…For the CDI cohort, because recurrent disease is common within 3 months of an event, we assessed readmissions within 90 days of discharge. 33,34 Patients who died within 1 year of discharge for MRSA, VRE, and ESBL cohorts and 90 days of discharge for CDI cohorts were excluded to prevent bias from differential loss to follow-up. By means of patient-specific record linking numbers from the mandatory hospitalization data set, all subsequent readmissions in any licensed California acute care medical center were identified among carriers and noncarriers.…”

Incidencia de bacterias multi-resistentes en unidades de cuidados intensivos de hospitales chilenos

“…Se les solicitó vía correo electrónico información del período comprendido entre el 01 de enero de 2014 y el 31 de octubre de 2015. La metodología utilizada en la recolección y análisis de datos es la descrita en documento publicado recientemente por el GCRB 5 , en concordancia con recomendaciones de SHEA/HICPAC 2008 6 . Se incluyeron los Servicios de UCI adultos (quirúrgico, médico, médico-quirúrgico o generales) y pediátricos.…”

Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update

“…42, 43 More specific details regarding these metrics (eg, definitions, methods of calculation) are available in the original SHEA/HICPAC position paper. 44 In addition to calculating outcome measures locally, hospitals that report MRSA data to the CDC's NHSN Multidrug Resistant Organism and C. difficile Infection (MDRO/CDI) Module have the option of having a number of outcome measures calculated automatically using the NHSN system. 42 The metrics included in this NHSN module are similar to some of those described in the SHEA/HICPAC position paper.…”

“…42 The metrics included in this NHSN module are similar to some of those described in the SHEA/HICPAC position paper. 44 Relative to MRSA, certain outcome measures are available to hospitals that submit only bloodstream isolate data (eg, hospital-onset MRSA BSI incidence), while additional outcome data are available to those who submit information regarding MRSA isolates from other clinical specimens or from AST. II.…”