Journal Features VA Research on Combating Multi-drug Resistant Organisms Posing Public Health Threat

BACKGROUND:
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. As an integrated healthcare system with acute care, community living centers, and community-based outpatient clinics, VA provides an ideal setting in which to study MDRO prevention and make a significant impact. Thus, a group of HSR&D infectious disease researchers and operations partners convened in Iowa City, IA, in September 2016. Conference participants included experts in hospital epidemiology, antimicrobial stewardship, medical anthropology, clinical medicine, infection prevention, pharmacy, and sociology. The participants were divided into four subgroups, to work together to identify key knowledge gaps and important targets for future investigation. Articles resulting from this collaboration include:

• Transmission dynamics: Resistant pathogens are spread via human hands and environmental surfaces. Disrupting this transmission is essential to controlling MDROs. In this article, Perencevich and colleagues 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.
• Antimicrobial stewardship: Strategies to improve the use of antibiotics and antifungals can reduce antibiotic resistance and improve clinical outcomes for patients. To improve antibiotic stewardship strategies, Suda and colleagues emphasize that research must focus on optimizing structures for healthcare teams leading these efforts, refining the activities implemented, determining dosing and duration of use, and using metrics for predicting changes in resistance.
• Microbiome: There may be ways to manipulate the human microbiome to eradicate or prevent colonization by resistant pathogens. Safdar and colleagues note the importance of establishing a framework for microbiome research and prioritizing certain study designs, such as longitudinal studies and randomized controlled trials. They also recommend further study of the efficacy of Fecal Microbiota Transplantation, and of additional microbiota research beyond the gastrointestinal tract.
• Special populations: Protocols commonly used to reduce the risk of healthcare-associated infections and MDROs in the hospital setting may be inappropriate or inadequate for healthcare personnel and patients in other settings. Evans and colleagues outline specific care settings that should be prioritized, including long-term care, spinal cord injury/disorder, rehabilitation, mental health care, ambulatory care, and home-based care.

Infection Control & Hospital Epidemiology. February 8, 2018;39(2):186-213.