Hospital Acquired Infections

VA Research Combats Multi-drug Resistant Organisms Posing Public Health Threat

September 7, 2018

Multi-drug resistant organisms (MDROs), including methicillin-resistant Staphylococcus aureus (MRSA) infection, are defined as bacteria that have become resistant to all but one or two antimicrobial agents. “Multi-drug 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,” said Eli Perencevich, MD, MS, Director of HSR&D’s Center for Comprehensive Access & Delivery Research and Evaluation (CADRE). As the nation’s largest integrated healthcare system, VA is leading efforts to prevent the spread of dangerous MDROs.

VA introduced the Methicillin-resistant Staphylococcus aureus (MRSA) Prevention Initiative in 2007. Although the Initiative was perceived as only targeting MRSA, it also expanded infection prevention and control programs and resources, which could result in lower rates of infection with other pathogenic bacteria. In one study, researchers assessed the effect of the MRSA Initiative on hospital-onset (HO) gram-negative rod (GNR) bacteremia (E coli, Klebsiella and Pseudomonas) at 130 VA facilities from January 2003 to December 2013. Findings show:

• Over the 11-year study period, the nationwide infection control program expansion that was part of the MRSA Initiative was strongly associated with a sustained and statistically significant 43% decline in HO GNR bacteremia rates.¹

Also, part of VA’s continuing efforts to decrease rates of MDROs, a group of HSR&D infectious disease researchers and operations partners convened in September 2016 to identify key knowledge gaps and important targets for future investigation. Articles resulting from this collaboration were featured nationally in Infection Control & Hospital Epidemiology in 2018.  Some of the important information in this issue includes:

• Disrupting transmission is essential to controlling MDROs. Authors outline the keystones of transmission prevention and opportunities for further investigation in hand hygiene surveillance and improvement, active surveillance, isolation measures, and enhanced environmental cleaning interventions.
• To improve antibiotic stewardship strategies, research must focus on optimizing structures for healthcare teams leading efforts, refining the activities implemented, determining dosing and duration of use, and using metrics for predicting changes in antibiotic resistance.
• Specific care settings should be prioritized to decrease the risk of healthcare-associated infections and MDROs, including long-term care, spinal cord injury/disorder, rehabilitation, mental health care, ambulatory care, and home-based care.²

1. Goto M, O’Shea A, Livorsi D, et al and Perencevich E. The effect of a nationwide infection control program expansion on hospital-onset gram-negative rod bacteremia in 130 Veterans Health Administration Medical Centers: An interrupted time series analysis. Clinical Infectious Diseases. September 1, 2016;63(5):642-50.
2. Infection Control & Hospital Epidemiology. February 8, 2018;39(2):186-213.