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Antimicrobial Drug Resistance (AMDR)

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          b. Surveillance



b. Surveillance

Surveillance is a critically important component of any infection control program, allowing detection of newly emerging pathogens, monitoring epidemiologic trends, and measuring the effectiveness of interventions. Multiple MDRO surveillance strategies have been employed, ranging from surveillance of clinical microbiology laboratory results obtained as part of routine clinical care to use of active surveillance cultures (ASC) to detect asymptomatic colonization. In the United States, legislative mandates for the use of surveillance systems for infection control have started to be implemented at the state level (Weber et al. 2007), while several European countries have imposed aggressive national surveillance programs that have contributed to low MDRO rates (Monnet and Kristinsson 2008). 

The simplest form of MDRO surveillance is the monitoring of clinical microbiology isolates resulting from tests ordered as part of routine clinical care. This method is particularly useful to detect emergence of new MDROs within either individual healthcare or community-wide facilities. Some investigators have used clinical microbiology results to calculate the incidence of MDROs in specific populations or patient care locations (eg, new MDRO isolates/1000 patient days, new MDRO isolates/month). Such measures may be useful for monitoring MDRO trends and assessing the impact of prevention programs. Clinical cultures can also be used to identify targeted MDRO infections in certain patient populations or units. This strategy requires investigation of clinical circumstances surrounding a positive culture to distinguish colonization from infection, but it can be particularly helpful in defining the clinical impact of MDROs within a facility. Many investigators have used molecular typing of selected isolates to confirm clonal transmission, enhancing understanding of MDRO transmission and the effect of interventions within their facility. 

Another form of MDRO surveillance is the use of ASC to identify patients who are colonized with a targeted MDRO. This approach is based on the observation that, for some MDROs, detection of colonization may be delayed or missed completely if culture results obtained in the course of routine clinical care are the primary means of identifying colonized patients. 

Use of geographic information combined with the genotyping of the microorganism(s) can help with the identification of the sequence of the source and transmission pathways of AMDR within and outside the healthcare setting (Harris et al. 2010).

A resolution prohibiting the use of certain type of clothing, such as neckties, long-sleeved shirts, and excess garments, in the healthcare setting is being considered by the American Medical Association. The concern is that such clothing might serve as vectors for transmitting infections. Several healthcare institutions in the United States are already banning the use of scrubs worn outside of healthcare facilities.


This resolution follows a similar move by the British Medical Association, which recommended that doctors stop wearing what it has dubbed “functionless” clothing.

Antibiotic Drug Therapy Targeting AMDR Prevention:

  • Proper selection and administration
  • Combining 2 or more antibiotics if indicated
  • Avoiding sequential antibiotic use
  • Early initiation of appropriate antibiotic treatment

 




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Table of Contents

ACTIVITY OVERVIEW
INTRODUCTION
SECTION ONE: The global threat of AMDR
SECTION TWO: Understanding AMDR
    1. Etiology and Epidemiology
    2. Incidence and Prevalence of Microbial Resistance
    3. Major AMDR Pathogens
       a. Acinetobacter baumanii
       b. Clostridium difficile
       c. Escherichia coli
       d. HIV/AIDS and Sexually Transmitted Infection
       e. Influenza virus
       f. Malaria (Plasmodium)
       g. Methicillin-resistant Staphylococcus aureus (MRSA)
       h. Streptococcus pneumoniae
       i. Tuberculosis and MDR-TB
       j. Vancomycin-Resistant Enterococcus (VRE)
SECTION THREE: Control and Prevention of AMDR
    1. Implications of Microbial Resistance
    2. Infections and Chronic Diseases
    3. Policies and Best Practices
       a. Antimicrobial Drug Stewardship
       b. Surveillance
       c. Environmental Decontamination
       d. Infection Control
       e. Patient Education
    4. Antibiotic Development Pipeline
SECTION FOUR: Conclusions
REFERENCES
APPENDICES
GLOSSARY
Test Questions
Program Evaluation
Self Assessment


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