American Journal of Infection Control
Management of multidrug-resistant organisms in health care settings, 2006
Section snippets
MDRO definition
For epidemiologic purposes, MDROs are defined as microorganisms, predominantly bacteria, that are resistant to 1 or more classes of antimicrobial agents.1 Although the names of certain MDROs describe resistance to only 1 agent (eg, MRSA, VRE), these pathogens are frequently resistant to most available antimicrobial agents. These highly resistant organisms deserve special attention in health care facilities.2 In addition to MRSA and VRE, certain GNB, including those producing extended spectrum
Trends
Prevalence of MDROs varies temporally, geographically, and by health care setting.70, 71 For example, VRE emerged in the eastern United States in the early 1990s but did not appear in the western United States until several years later, and MDRSP varies in prevalence by state.72 The type and level of care also influence the prevalence of MDROs. ICUs, especially those at tertiary care facilities, may have a higher prevalence of MDRO infections than do non-ICU settings.73, 74 Antimicrobial
Prevention of infections
Preventing infections will reduce the burden of MDROs in health care settings. Prevention of antimicrobial resistance depends on appropriate clinical practices that should be incorporated into all routine patient care. These include optimal management of vascular and urinary catheters, prevention of lower respiratory tract infection in intubated patients, accurate diagnosis of infectious etiologies, and judicious antimicrobial selection and utilization. Guidance for these preventive practices
Discussion
This review demonstrates the depth of published science on the prevention and control of MDROs. Using a combination of interventions, MDROs in endemic, outbreak, and nonendemic settings have been brought under control. However, despite the volume of literature, an appropriate set of evidence-based control measures that can be universally applied in all health care settings has not been definitively established. This is due in part to differences in study methodology and outcome measures,
Prevention of transmission of MDROs
The CDC/HICPAC system for categorizing recommendations is as follows:
Category IA: Strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies.
Category IB: Strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies and a strong theoretical rationale.
Category IC: Required for implementation, as mandated by federal and/or state regulation or standard.
Category II: Suggested for
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Inquires should be directed to Michael Bell, MD, Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. E-mail: [email protected]
Healthcare Infection Control Practices Advisory Committee (HICPAC): Chair: Patrick J. Brennan, MD, Professor of Medicine, Division of Infectious Diseases, University of Pennsylvania Medical School; Executive Secretary: Michael Bell, MD, Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention; Members: Vicki L. Brinsko, RN, BA, Infection Control Coordinator, Vanderbilt University Medical Center; E. Patchen Dellinger, MD, Professor of Surgery, University of Washington School of Medicine; Jeffrey Engel, MD, Head, General Communicable Disease Control Branch, North Carolina State Epidemiologist; Steven M. Gordon, MD, chairman, Department of Infections Diseases, Hospital Epidemiologist, Department of Infectious Disease, Cleveland Clinic Foundation; Lizzie J. Harrell, PhD, D(ABMM), Research Professor of Molecular Genetics, Microbiology, and Pathology; Associate Director of Clinical Microbiology, Duke University Medical Center; Carol O'Boyle, PhD, RN, Assistant Professor, School of Nursing, University of Minnesota; David Alexander Pegues, MD, Division of Infectious Diseases, David Geffen School of Medicine at UCLA; Dennis M. Perrotta, PhD, CIC, Adjunct Associate Professor of Epidemiology, University of Texas School of Public Health and Texas A&M University School of Rural Public Health; Harriett M. Pitt, MS, CIC, RN, Director of Epidemiology, Long Beach Memorial Medical Center; Keith M. Ramsey, MD, Professor of Medicine, Medical Director of Infection Control, The Brody School of Medicine at East Carolina University; Nalini Singh, MD, MPH, Professor of Pediatrics, Epidemiology, and International Health, The George Washington University Children's National Medical Center; Kurt Brown Stevenson, MD, MPH, Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Medical Center; Philip W. Smith, MD, Chief, Section of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center.
HICPAC membership (past): Robert A. Weinstein, MD, (Chair) Cook County Hospital, Chicago, IL; Jane D. Siegel, MD (Cochair), University of Texas Southwestern Medical Center, Dallas, TX; Michele L. Pearson, MD (Executive Secretary), Centers for Disease Control and Prevention, Atlanta, GA; Raymond Y.W. Chinn, MD, Sharp Memorial Hospital, San Diego, CA; Alfred DeMaria, Jr, MD, Massachusetts Department of Public Health, Jamaica Plain, MA; James T. Lee, MD, PhD, University of Minnesota Minneapolis, MN; William A. Rutala, PhD, MPH, University of North Carolina Health Care System, Chapel Hill, NC; William E. Scheckler, MD, University of Wisconsin, Madison, WI; Beth H. Stover, RN Kosair Children's Hospital, Louisville, KY; Marjorie A. Underwood, RN, BSN, CIC, Mt. Diablo Medical Center, Concord, CA.
HICPAC Liaisons: William B. Baine, MD, Liaison to Agency for Healthcare Quality Research; Joan Blanchard, RN, MSN, CNOR Liaison to Association of PeriOperative Registered Nurses; Nancy Bjerke, RN, MPH, CIC, Liaison to Association of Professionals in Infection Prevention and Control; Patrick J. Brennan, MD, Liaison to Board of Scientific Counselors; Jeffrey P. Engel, MD, Liaison to Advisory Committee on Elimination of Tuberculosis; David Henderson, MD, Liaison to National Institutes of Health; Lorine J. Jay, MPH, RN, CPHQ, Liaison to Healthcare Resources Services Administration; Stephen F. Jencks, MD, MPH, Liaison to Center for Medicare and Medicaid Services; Sheila A. Murphey, MD, Liaison to Food and Drug Administration; Mark Russi, MD, MPH, Liaison to American College of Occupational and Environmental Medicine; Rachel L. Stricof, MPH, Liaison to Advisory Committee on Elimination of Tuberculosis; Michael L. Tapper, MD, Liaison to Society for Healthcare Epidemiology of America; Robert A. Wise, MD, Liaison to Joint Commission on the Accreditation of Healthcare Organizations.