1603. Variation in Definitions and Isolation Procedures for Multidrug-resistant Gram-negative Bacilli: a Survey of the SHEA Research Network
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • 2013 ID week SHEA epi project poster_FINAL.pdf (227.4 kB)
  • Background:   The emergence of multidrug-resistant Gram-negative bacilli (MDR GNB), including Klebsiella, Acinetobacter and Pseudomonas, has been a major challenge for healthcare facilities.  There is little guidance as to how to isolate patients harboring these organisms.

    Methods:   We conducted an online cross-sectional survey of members of the SHEA Research Network (SRN) during Nov 2012-Feb 2013 to assess infection control practices regarding MDR GNB.  The survey included definitions and infection control procedures related to MDR GNB. 

    Results:   Of 200 SRN members, 69 responded (35% response rate), representing 26 states and 15 countries.  Participants varied regarding definitions of “multidrug resistant,” with 15 unique definitions for Acinetobacter, 17 for Pseudomonas, and 23 for Enterobacteriaceae species. The most common definition for each was resistance to ≥3 classes of antimicrobials (25-43%).  Substantial variation existed in isolation practices for patients with MDR GNB (Table).  Most (≥80%) facilities reported experience with each MDR-GNB isolate and 78% have encountered pan-resistant MDR-GNB (ie, susceptible only to colisitin). Approximately 20% of facilities did not isolate for MDR Pseudomonas or Acinetobacter and > 50% allowed removal of isolation for patients with known MDR GNB.

    Conclusion:   Facilities vary significantly in their approach to prevent MDR GNB transmission.  Inconsistent definitions of MDR may hinder communication during patient transfers.  Many (25- 43%) hospitals remove isolation for MDR GNB without requiring negative cultures and 17-26% do not isolate certain MDR GNB at all.  Inconsistent definitions and use of isolation practices may be contributing to the ongoing epidemic of MDR GNB.

    ESBL

    %

    CRE

    %

    MDR Pseudomonas

    %

    MDR Acinetobacter

    %

    Use isolation for patients with organism

    73.9

    94.2

    79.7

    82.6

    Duration of isolation:

          During active illness/until
          completion of antibiotics

    9.3

    10.0

    10.7

    9.8

          Duration of hospitalization:

    29.6

    15.0

    32.1

    32.8

          Until negative surveillance
          cultures obtained

    31.5

    33.3

    33.9

    30.4

          Indefinitely

    33.3

    46.7

    30.4

    31.1

    Isolation of readmitted patients

          Yes

    53.7

    73.8

    50.0

    54.5

          Depends on clinical factors/
          timing

    6.0

    4.6

    15.2

    16.7

    Active surveillance performed in ≥1 area of hospital

    17.4

    20.3

    7.2

    14.5

    Marci Drees, MD, MS1,2, Lisa Pineles, MA3, Anthony Harris, MD, MPH4 and Daniel Morgan, MD, MS3,5, (1)Christiana Care Health System, Newark, DE, (2)Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA, (3)Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (4)Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, (5)Baltimore VA Medical Center, Baltimore, MD

    Disclosures:

    M. Drees, None

    L. Pineles, None

    A. Harris, None

    D. Morgan, Welch Allyn : Consultant, Consulting fee
    Sanogiene : Consultant, Consulting fee

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.