388. The Multidrug-resistant Organism Repository and Surveillance Network
Session: Poster Abstract Session: Gram Negative Infection - Epidemiology and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • idsa2011.pdf (1.2 MB)
  • Background: The Multidrug-resistant organism Repository and Surveillance Network (MRSN) was launched in July 2009 to centralize and standardize the collection, characterization, and reporting of multidrug-resistant organisms (MDRO) across the military health system (MHS).

    Methods: Hospitals submit targeted MDRO as they are isolated from infections or surveillance activities to the MRSN. Isolates undergo identity and susceptibility confirmation in triplicate on all the major automated platforms, pulsed-field gel electrophoresis (PFGE) and real-time polymerase chain reaction for blaNDM-1, blaVIM, armA, rmtB, rmtB, and qacA/B genes, and archival cryopreservation. Selected strains also undergo optical genome mapping and sequencing. Regular reports (such as monthly antibiograms) and event-driven outbreak or emerging pathogen reports are sent to clinicians, infection control teams, and policy makers.  The MRSN uses PFGE protocols identical to the Centers for Disease Control and Prevention, for improved data comparison and sharing.   Targeted canine MDRO are collected at the breeding and training centers for military working dogs and are analyzed for clonal relatedness and spread.

    Results: To date, 9 referral centers and their satellite hospitals (including 3 in war zones) submit isolates. 3500 isolates have been collected, characterized and archived. BlaNDM-1 was detected in Providencia stuartii from Afghanistan, and qacA/B was detected in 6 clonally unrelated methicillin-resistant Staphylococcus aureus from a regional network in the National Capital area. Assistance with outbreak investigation was requested 10 times.  Turn-around time from the request by the facility for laboratory assistance to the feedback of actionable information ranged from 3.5 days for hospitals in the U.S. to 13 days for hospitals in Afghanistan and the hospital ship U.S. Comfort stationed off the coast of Haiti.

    Conclusion: The MRSN unburdened clinical laboratories of outbreak investigations, determined sources of outbreaks, interrupted nosocomial transmission of a clone involved in a fatal healthcare-associated infection, influenced surveillance policy, and was the first to report entry of resistance genes in the MHS (BlaNDM-1) and the U.S. (qacA/B).


    Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

    Paige Waterman, MD1,2, Amy Summers, BS, MT2, Yoon Kwak, MS2, Robert Clifford, PhD2, Chad Black, DVM2, Mohamad Chahine, MD2, Matthew Riley, MS2, Patrick Mc Gann, PhD2 and Emil Lesho, DO1,2, (1)Uniformed Services University, Bethesda, MD, (2)Walter Reed Army Institute of Research, Silver Spring, MD

    Disclosures:

    P. Waterman, None

    A. Summers, None

    Y. Kwak, None

    R. Clifford, None

    C. Black, None

    M. Chahine, None

    M. Riley, None

    P. Mc Gann, None

    E. Lesho, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.