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Practices, definitions for MDR organisms vary between hospitals
Significant variation in the definitions of multidrug-resistant gram-negative bacteria, as well in procedures to prevent transmission of these organisms, exists among acute care hospitals, researchers reported in Infection Control and Hospital Epidemiology.
“Differences in definitions and practices for multidrug-resistant bacteria confuse health care workers and hinder communication when patients are transferred between hospitals,” Marci Drees, MD, MS, of the department of medicine at Christiana Care Health System in Wilmington, Del., said in a press release. “The danger these inconsistencies represent affects not only individual hospitals, but the broader community because patients are frequently transferred between health care centers, including long-term care facilities, furthering their spread.”
Marci Drees
Drees and colleagues conducted a cross-sectional survey that was sent to 170 Society for Healthcare Epidemiology of America (SHEA) Research Network members, 66 of whom responded. The responses represent 26 states and 15 countries. Most facilities reported experience with an MDR gram-negative isolate. Most also had experience with isolates resistant to all antibiotics except for colistin: 62% Acinetobacter, 59% Pseudomonas and 52% Enterobacteriaceae species.
Researchers found that there were 14 unique definitions for Acinetobacter, 18 for Pseudomonas and 22 for Enterobacteriaceae. The most common definition of multidrug resistance was resistance to three or more classes of antimicrobials. Other definitions included resistance to one or more specific antibiotics or classes and susceptibility to two or fewer antibiotic classes that did not include polymyxin or tigecycline (Tygacil, Pfizer). For Enterobacteriaceae species, extended-spectrum beta-lactamase (ESBL) production also was considered a definition of resistance.
Isolation practices also varied across species and definition of resistance. In addition, more than 90% of the respondents reported placing patients with MRSA, vancomycin-resistant enterococci and carbapenem-resistant Enterobacteriaceae (CRE) in isolation, but 20% to 30% of respondents reported not isolating patients with ESBL-producing bacteria, MDR Pseudomonas or Acinetobacter. Duration of isolation also varied, ranging from isolation during active illness or until completion of antibiotics to indefinite isolation, which was most common for CRE.
“Public health agencies need to promote standard definitions and management to enable broader initiatives to limit emergence of multidrug-resistant bacteria,” Drees said.
Disclosure: The researchers report no relevant financial disclosures.