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VHA research agendas target multidrug-resistant organisms
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A group of experts, convened under the Veterans Health Administration, published a series of research agendas that describe gaps in knowledge about multidrug-resistant organisms and key targets for preventing infection.
The publications highlight research needs in four areas: transmission dynamics of multidrug-resistant organisms (MDROs), antimicrobial stewardship, the microbiome and infection prevention interventions in special patient populations. All of the agendas were published in Infection Control & Hospital Epidemiology.
“Multidrug-resistant organisms cause infections that are very difficult to treat. This threat goes beyond the medical community. It is a public health crisis waiting to happen,” Eli Perencevich, MD, MS, director of the Center for Comprehensive Access and Delivery Research and Evaluation at the Iowa City Veterans Affairs Health Care System, said in a press release. “These four articles will help set the research agenda and provide a starting point for other health care systems to implement, or improve upon, in their own approaches.”
The first research agenda addresses a lack of data on MDRO transmission in acute-care settings. Perencevich and colleagues said future studies should investigate the best strategies for reducing transmission. There is a specific need to explore the effectiveness and cost-effectiveness of hand hygiene interventions, active surveillance, isolation measures and environmental cleaning, as well as adherence issues with these strategies, according to the researchers.
In the second research agenda, Katie J. Suda, PharmD, MS, a research health scientist at the Center of Innovation for Complex Chronic Healthcare at the Edward Hines Jr. Veterans Administration Hospital, and colleagues said future antimicrobial stewardship studies should explore interventions that can be implemented in the absence of infectious disease specialists because many facilities cannot afford to staff them. The researchers also called for the establishment of standard metrics that can accurately assess antimicrobial prescribing and changes in resistance.
“The impact stewardship has on antimicrobial resistance will always be confounded by how successfully infection prevention practices prevent patient-to-patient transmission of resistant organisms,” they wrote. “Stewardship programs should also quantify clinical outcomes, including infection-related deaths and infection-related readmissions.”
The third research agenda focuses on microbiome research and the need to better understand how the microbiome influences MDRO infections. Ashley E. Kates, PhD, of the William S. Middleton Memorial Veterans Affairs Hospital and department of medicine at the University of Wisconsin, and colleagues said hospital epidemiologic studies should incorporate longitudinal microbiota data to examine changes in the human microbiome over time. Future trials should also investigate the role of nasal and dermal microbiomes in MDRO infection and transmission, and whether fecal microbiota transplantation can eliminate MDROs from the gastrointestinal tract.
The final research agenda examines health care-associated infections (HAIs) due to MDROs in special populations, including patients with spinal cord injuries and those receiving long-term care, ambulatory care, mental health care, home-based care or hospice, and dialysis. According to Charlesnika T. Evans, PhD, MPH, also of the William S. Middleton Memorial Veterans Affairs Hospital, and colleagues, most data on HAIs with MDROs are from acute-care settings. However, they reported that protocols often used to reduce HAIs and MDROs in acute-care facilities may be inadequate for other patient populations. Therefore, effective strategies for providing “safe health care” in other settings are needed.
“It is our hope that these proposed agendas will spur collaborative research across the VHA and throughout health care in the study of MDRO prevention,” Perencevich and colleagues wrote in a related commentary. “With sustained, coordinated and aggressive efforts across the spectrum of discovery to dissemination, the current MDRO crisis may evolve into a more manageable problem.” – by Stephanie Viguers
References:
Evans CT, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.291.
Kates AE, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.311.
Livorsi DJ, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.302.
Perencevich EN, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.309.
Suda KJ, et al. Infect Control Hosp Epidemiol. 2018;doi:10.1017/ice.2017.299.
Disclosures: Evans, Kates, Perencevich and Suda report no relevant financial disclosures. One study author reports having patents for the treatment and prevention of Clostridium difficile infection. He is also a member of advisory boards for Actelion, DaVolterra, Merck, Rebiotix and Summit, and is a consultant for MGB Pharma, Pfizer and Sanofi Pasteur.
Perspective
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Keith S. Kaye, MD, MPH
These recommendations set the stage for future research agendas regarding the prevention, acquisition and dissemination of MDROs. Hospitals and health care systems have been working to combat the crisis of antimicrobial resistance for years, and although progress has been made, there remains much to learn and address as we move forward. With the publishing of these manuscripts, the VHA has taken a leading role in this endeavor by coordinating efforts and promoting sustainable interventions that will take health care in a positive direction with regards to MDRO prevention. These papers provide useful advice for researchers and health care leaders to help ensure that resources are allocated appropriately, gaps in knowledge and practice are addressed in future studies, and important steps are taken to ensure the safety of patients everywhere.
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