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Further research on multidrug-resistant organisms needed
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There is a need for improved research and more extensive knowledge to better tackle the issue of multidrug-resistant organisms, according to a speaker at the National Immunization Conference in Atlanta.
Aaron Milstone, MD, an assistant professor of infectious diseases at Johns Hopkins University in Baltimore, reviewed past and present data and practices related to physicians’ experiences with multidrug-resistant organisms, noting deficits in pediatric research in this area.
Early epidemiological data pertaining to antimicrobial resistance was spearheaded by the Pediatric Prevention Network, according to Milstone. The network conducted the first national study on the prevalence of health care–associated infection in neonatal and pediatric ICU patients. The surveys, however, showed low numbers for both health care–associated infections and infections resulting from multidrug-resistant organisms, making it difficult for researchers to determine if these infections presented a significant problem.
Milstone said current national data do not exist in this area, with most results deriving from single-center studies. However, the CDC and National Healthcare Safety Network are now providing data on national rates of methicillin-resistant Staphylococcus aureus and device-associated infections through several studies.
Milstone also said looking at past and present interventional strategies is important so that physicians can gain insight into the best way to deal with these infections. He elaborated on the efficacy of multifaceted interventions, which combine strategies such as hand hygiene or screening health care workers — but noted that these were not specific to pediatrics.
Two strategies — contact isolation and decolonization — had promise for the pediatric population, according to Milstone. He cited a study by Jernigan and colleagues that showed contact isolation played a considerable role in containing a MRSA outbreak, and another study’s findings demonstrated the potential benefits of utilizing topical antibiotics such as mupirocin and topical antiseptics such as chlorhexidine in children.
“We need to determine and define the current multidrug-resistant organism prevalence and incidence; to look at subpopulations of children in whom interventions are effective and safe; and we need to evaluate whether nonevidence-based interventions always help patients,” Milstone said.
“People are listening, and money’s becoming available for research in this area. This is an exciting time for people who are interested and willing to contribute,” he said.
Milstone A. Infections caused by multidrug-resistant organisms. #342. Presented at: Fifth Decennial International Conference on Healthcare-Associated Infections; March 18-22, 2010; Atlanta.
Along with more research, there must be improved surveillance, including consideration for making these infections reportable conditions, and since, quite often, specific specimens for culture are not obtained, a report could be submitted on the basis of a “case definition” that meets certain criteria.
These infections are much more prevalent than what has been recognized and often lead to serious and life-threatening diseases that can be better controlled.
– Fernando A. Guerra, MD, MPH
Director of Health, MetroHealth
San Antonio