In the Journals

Hospital surveillance data show shift in focus from MRSA to gram-negative bacteria

Kathleen Chiotos, MD, MSCE
Kathleen Chiotos

A survey of health care facilities in the United States and 11 other countries found that, since 2013, active surveillance for MRSA has declined, and more than half of facilities now report active surveillance for carbapenem-resistant Enterobacteriaceae, or CRE, suggesting a shift in focus toward gram-negative bacteria, researchers said.

The survey results further showed that, between 2013 and 2018, support for antimicrobial stewardship programs increased. However, despite an expected increase in responsibilities for infection prevention and control and antimicrobial stewardship programs, most facilities said they did not expect to receive additional funding or resources, according to the researchers.

The survey was conducted within the Society for Healthcare Epidemiology of America Research Network (SRN) “a large consortium of health care facilities dedicated to conducting high-quality studies related to infection prevention and control and antibiotic stewardship,” Kathleen Chiotos, MD, MSCE, attending physician in the pediatric ICU at The Children’s Hospital of Philadelphia and assistant professor of anesthesiology and critical care at the Perelman School of Medicine at the University of Pennsylvania, told Infectious Disease News.

The SRN includes 132 facilities from around the world that conduct collaborative research projects in health care epidemiology and antibiotic stewardship. The researchers invited all participating SRN members to participate in a survey between July 12, 2018, and Aug. 10, 2018, and compared the findings with a similar survey conducted in 2013.

The response rate was 48%, with 64 facilities completing the survey, according to Chiotos and colleagues. The responding facilities included 47 U.S. hospitals and 17 international facilities representing 11 countries.

In both surveys, active surveillance was most common for MRSA, although the proportion of hospitals that reported performing surveillance for MRSA declined from 90% in 2013 to 69% in 2018.

“This finding may reflect a response to surveillance recommendations made in the 2015 Centers for Disease Control and Prevention CRE toolkit, coupled with data demonstrating no significant reduction in MRSA transmission with active surveillance and use of contact precautions,” Chiotos and colleagues explained.

According to the researchers, in 2018, 50% of hospitals reported active surveillance for CRE, which was not measured in 2013.

Formal surveillance of health care-associated infections was commonly reported in both surveys. In 2018, 100% of hospitals reporting surveillance for central line-associated bloodstream infections (CLABSIs), 97% for surgical site infections (SSIs), 95% for catheter-associated UTIs (CAUTIs) and 81% for ventilator-associated pneumonia/ventilator-associated events, Chiotos and colleagues reported.

According to the study, 78% of hospitals publicly reported CLABSIs, 77% publicly reported SSIs, 75% publicly reported CAUTIs, 73% publicly reported hospital-onset Clostridioides difficile and 69% publicly reported hospital-onset MRSA bacteremia.

Almost all — 98% — of hospitals in 2018 reported monitoring the effectiveness of environmental cleaning, compared with 80% in 2013, findings showed. Furthermore, 37% of facilities reported use of ultraviolet light for environmental cleaning in 2018.

In 2013, 85% of facilities had an antimicrobial stewardship program compared with 95% in 2018, and the proportion of facilities providing financial support for physician stewardship medical directors and stewardship pharmacists increased from 52% to 78% in the last 5 years, the survey showed.

“Our survey demonstrated that surveillance for antibiotic-resistant bacteria continues to be a core focus for health care facilities,” Chiotos said. “Our work further highlights the growth in financially supported antibiotic stewardship programs over the past 5 years, as well as frequent use of rapid molecular diagnostic tests to expedite appropriate antibiotic therapy for patients with bloodstream infections. Finally, while half of facilities anticipated increased responsibilities for infection control and antibiotic stewardship staff, the minority anticipated increases in funding for this important work.” – by Marley Ghizzone

Disclosures: Chiotos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Kathleen Chiotos, MD, MSCE
Kathleen Chiotos

A survey of health care facilities in the United States and 11 other countries found that, since 2013, active surveillance for MRSA has declined, and more than half of facilities now report active surveillance for carbapenem-resistant Enterobacteriaceae, or CRE, suggesting a shift in focus toward gram-negative bacteria, researchers said.

The survey results further showed that, between 2013 and 2018, support for antimicrobial stewardship programs increased. However, despite an expected increase in responsibilities for infection prevention and control and antimicrobial stewardship programs, most facilities said they did not expect to receive additional funding or resources, according to the researchers.

The survey was conducted within the Society for Healthcare Epidemiology of America Research Network (SRN) “a large consortium of health care facilities dedicated to conducting high-quality studies related to infection prevention and control and antibiotic stewardship,” Kathleen Chiotos, MD, MSCE, attending physician in the pediatric ICU at The Children’s Hospital of Philadelphia and assistant professor of anesthesiology and critical care at the Perelman School of Medicine at the University of Pennsylvania, told Infectious Disease News.

The SRN includes 132 facilities from around the world that conduct collaborative research projects in health care epidemiology and antibiotic stewardship. The researchers invited all participating SRN members to participate in a survey between July 12, 2018, and Aug. 10, 2018, and compared the findings with a similar survey conducted in 2013.

The response rate was 48%, with 64 facilities completing the survey, according to Chiotos and colleagues. The responding facilities included 47 U.S. hospitals and 17 international facilities representing 11 countries.

In both surveys, active surveillance was most common for MRSA, although the proportion of hospitals that reported performing surveillance for MRSA declined from 90% in 2013 to 69% in 2018.

“This finding may reflect a response to surveillance recommendations made in the 2015 Centers for Disease Control and Prevention CRE toolkit, coupled with data demonstrating no significant reduction in MRSA transmission with active surveillance and use of contact precautions,” Chiotos and colleagues explained.

According to the researchers, in 2018, 50% of hospitals reported active surveillance for CRE, which was not measured in 2013.

Formal surveillance of health care-associated infections was commonly reported in both surveys. In 2018, 100% of hospitals reporting surveillance for central line-associated bloodstream infections (CLABSIs), 97% for surgical site infections (SSIs), 95% for catheter-associated UTIs (CAUTIs) and 81% for ventilator-associated pneumonia/ventilator-associated events, Chiotos and colleagues reported.

PAGE BREAK

According to the study, 78% of hospitals publicly reported CLABSIs, 77% publicly reported SSIs, 75% publicly reported CAUTIs, 73% publicly reported hospital-onset Clostridioides difficile and 69% publicly reported hospital-onset MRSA bacteremia.

Almost all — 98% — of hospitals in 2018 reported monitoring the effectiveness of environmental cleaning, compared with 80% in 2013, findings showed. Furthermore, 37% of facilities reported use of ultraviolet light for environmental cleaning in 2018.

In 2013, 85% of facilities had an antimicrobial stewardship program compared with 95% in 2018, and the proportion of facilities providing financial support for physician stewardship medical directors and stewardship pharmacists increased from 52% to 78% in the last 5 years, the survey showed.

“Our survey demonstrated that surveillance for antibiotic-resistant bacteria continues to be a core focus for health care facilities,” Chiotos said. “Our work further highlights the growth in financially supported antibiotic stewardship programs over the past 5 years, as well as frequent use of rapid molecular diagnostic tests to expedite appropriate antibiotic therapy for patients with bloodstream infections. Finally, while half of facilities anticipated increased responsibilities for infection control and antibiotic stewardship staff, the minority anticipated increases in funding for this important work.” – by Marley Ghizzone

Disclosures: Chiotos reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.