Active Surveillance for Multidrug-resistant Organisms

Sung Kuk Hong; Taek Soo Kim; Kyoung Un Park; Jae-Seok Kim; Eui-Chong Kim

doi:10.5145/ACM.2013.16.2.53

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Hong, Kim, Park, Kim, and Kim: Active Surveillance for Multidrug-resistant Organisms

Original Article

Ann Clin Microbiol 2013;16(2):53-60.

Published online: 5 June 2013

DOI: https://doi.org/10.5145/ACM.2013.16.2.53

Active Surveillance for Multidrug-resistant Organisms

Sung Kuk Hong¹, Taek Soo Kim^1,², Kyoung Un Park^1,², Jae-Seok Kim³, Eui-Chong Kim¹

¹Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea

²Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

³Hallym University College of Medicine, Seoul, Korea

Correspondence: Kyoung Un Park, Department of Laboratory Medicine, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bun-dang-gu, Seongnam 463-707, Korea. (Tel) 82-31-787-7692, (Fax) 82-31-787-4015, (E-mail) m91w95@dreamwiz.com

Received 4 October 20127 November 2012 Accepted 7 November 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Infections and outbreaks of antimicrobial-resistant ba-cteria, such as methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enteroco-ccus (VRE), have been increasing. Detection methods for antimicrobial-resistant bacteria have been changed from traditional culture methods to chromogenic media culture and molecular methods. Strain- typing methods using various molecular technologies are essential tools for epidemiologic surveillance. Furthermore, outbreak detection, using syndromic surveillance as well as passive and active surveillance, has been applied. However, it is difficult to establish effective and robust guidelines and systems for using these various methods to control antimicrobial-resi-stant bacteria. Therefore, clinical microbiologists and policy makers must possess expertise in the control of antimicrobial resistant bacteria, discuss the issue sufficiently, and, finally, create a system to accom-plish this control.

Keywords: Active surveillance, Mandatory active surveillance, Multidrug resistant organism

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Fig. 1.

Syndromic surveillance: rationale for early detection. *Time between detection by syndromic (prediagnostic) surveillance and detection by traditional (diagnosis-bases) surveillance. Figure is adapted from MMWR, 2004;53.

Fig. 2.

Legislative maps of methicillin-resistant Staphylococcus aureus in the United States. Figure is adapted from http://apic.org.

Table 1.

Sensitivity and specificity of currently available chromogenic media and molecular assays for methicillin-resistant Staphylococcus aureus

	Direct inoculation or OE, h of incubation	% sensitivity	% specificity	Reference
Chromogenic media
ChromID	Direct, 16-24 h	51.0-76.0	95.0-99.5	[7], [9], [11,12]
	Direct, 42-48 h	77.0-90.0	85.6-98.0	[7], [12,13]
	OE, 24 h	93.0-94.0	100.0	[9], [12]
MSRA Select	Direct, 16-24 h	65.0-99.0	98.0-100.0	[6], [8-12]
	Direct, 42-48 h	60.0-100.0	66.0-99.3	[6], [8,9], [11,12]
	OE, 24 h	96.0		[12]
CHROMagar MRSA	Direct, 16-24 h	40.0-82.9	88.0-100.0	[7], [9-11], [13]
	Direct, 42-48 h	72.0-79.0	79.0-97.0	[9], [11], [13]
	OE, 24 h	95.0	99.0	[9]
ORSAB	Direct, 16-24 h	47.0-91.9	67.0-99.0	[6,7], [9], [12,13]
	Direct, 42-48 h	67.0-96.0	68.0-98.0	[6,7], [9], [12,13]
	OE, 24 h	91.0		[12]
Chromogen Oxacillin	Direct, 24 h	1.0	5.0	[12]
S. aureus medium	Direct, 48 h	53.0	80.0	[12]
Molecular assay
Hyplex StaphyloResist	Direct	91.7	90.0	[14]
Hyplex StaphyloResist	OE, 18 h	97.6	83.7	[18]
LC Staphylococcus/	OE, 24 h	95.7	90.8	[16]
LC MRSA detection
IDI-MRSA/	Direct	80.0-100.0	89.0-99.0	[11], [17], [19-21]
GeneOhm MRSA	OE, 24 h	96.0	96.0	[22]
Genotype MRSA direct	Direct	68.0-94.6	96.0-98.7	[11], [12], [15]
GeneXpert MRSA	Direct	94.3	93.2	[23]

Table is adapted from Malhotra-Kumar et al., 2008.

Abbreviation: OE, overnight enrichment.

Table 2.

Required elements of an effective active surveillance program

Screening test

Must be timely, affordable, and reliable

Clinical efficacy

Should reduce transmission rate to patients and healthcare workers

Should reduce infection rate by preventing acquisition

Implementation

Hospital and administrative financial support

Systems and staff to screen patients

Systems and staff to monitor effectiveness and compliance

Education of patients, staff, and families

Adequate physical plant and supplies

(e.g., private rooms, gloves, gowns, and antimicrobial agents)

Plan to manage social isolation and safety of patients under contact precautions

Table isadapted from Weber et al., 2007.

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