Multidrug-Resistant Organisms (MDRO) Surveillance: How do We Look At The Picture, Horizontally or Vertically?

BACKGROUND Surveillance for multidrug-resistant organisms (MDRO) is a cornerstone for infection prevention efforts. High risk patients for MDRO colonization should be the focus of surveillance. The aim of this study is to evaluate the effectiveness of surveillance for patients with high risk clinical criteria for MDRO colonization within critical care units (CCU). METHODS An automated daily report was developed that alerted the infection control department of new intensive care unit (ICU) admissions with at least two of the following criteria: admission from an outside facility, readmission within 90?days, presence of a chronic wound, tracheostomy or indwelling catheters. A retrospective review of these clinical criteria was performed over the last two years with excellent correlation and reported. MDRO included Methicillin-resistant Staph aureus (MRSA), Vancomycin resistant Enterococci (VRE), Carbapenem resistant Enterobacteriaceae (CRE) and extended spectrum Beta lactamase producing organisms (ESBL). Rectal swabs and groin sponges were obtained on admission for MRSA, ESBL, CRE and VRE. RESULTS From October 1st, 2017 to April 30th, 2018 samples were collected from 200 CCU patients. MDRO was recovered from 30% and 22.4% of rectal and groin cultures respectively. Gram negative MDRO (ESBL & CRE) represented 71% of the pathogens isolated. Rectal cultures were more effective than groin cultures for capturing all MDRO. CONCLUSIONS Rectal and groin surveillance for CRE, ESBL, VRE and MRSA for high risk patients is a very effective method of establishing MDRO colonization. Identifying the colonization status of CCU patients is an essential step in hospital associated infection prevention and outbreak investigations.