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. 2013 Aug;20(8):17-22.

Active surveillance for asymptomatic colonization with multidrug-resistant gram negative bacilli among injured service members--a three year evaluation

Amy C Weintrob  1 , Clinton K Murray, Bradley Lloyd, Ping Li, Dan Lu, Zhuang Miao, Deepak Aggarwal, M Leigh Carson, Lakisha J Gaskins, David R Tribble
Affiliations

Active surveillance for asymptomatic colonization with multidrug-resistant gram negative bacilli among injured service members--a three year evaluation

Amy C Weintrob et al. MSMR. 2013 Aug.

Abstract

In response to the high rates of colonization and infection by multidrug-resistant gram-negative bacilli (MDR GNB), many military treatment facilities (MTFs) have implemented additional infection control practices, such as active surveillance cultures for asymptomatic colonization. Results of surveillance cultures (June 2009 - May 2012) collected from patients at Landstuhl Regional Medical Center (Landstuhl RMC), Germany, and three U.S. MTFs were analyzed to evaluate trends in MDR GNB colonization over time and across facilities. At Landstuhl RMC, 6.6 percent of patients were colonized on admission with MDR GNB compared to 12.4 percent of patients admitted to the participating U.S. MTFs. Escherichia coli was the predominant organism, representing 82.4 percent of MDR isolates at Landstuhl RMC and 67.1 to 83.3 percent at U.S. MTFs. Other common MDR GNB included Acinetobacter calcoaceticus-baumannii complex and Klebsiella pneumoniae. Although Pseudomonas aeruginosa was often isolated from the surveillance cultures, it was never multidrug-resistant. Annual rates of MDR GNB colonization were not significantly different over the three-year period. Ongoing research includes assessment of predictive factors for MDR GNB colonization and the relationship between colonization and infection.

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Figures

FIGURE 1
FIGURE 1
a: Landstuhl Regional Medical Center (LRMC) admissions and active surveillance cultures for asymptomatic colonization, June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli b: Landstuhl Regional Medical Center (LRMC) admissions and active surveillance cultures for asymptomatic colonization, restricted to the population of patients who transferred to the U.S. Military Treatment Facility (MTF), June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli c: U.S. Military Treatment Facility (MTF) admissions and active surveillance cultures for asymptomatic colonization, June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli
FIGURE 1
FIGURE 1
a: Landstuhl Regional Medical Center (LRMC) admissions and active surveillance cultures for asymptomatic colonization, June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli b: Landstuhl Regional Medical Center (LRMC) admissions and active surveillance cultures for asymptomatic colonization, restricted to the population of patients who transferred to the U.S. Military Treatment Facility (MTF), June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli c: U.S. Military Treatment Facility (MTF) admissions and active surveillance cultures for asymptomatic colonization, June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli
FIGURE 1
FIGURE 1
a: Landstuhl Regional Medical Center (LRMC) admissions and active surveillance cultures for asymptomatic colonization, June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli b: Landstuhl Regional Medical Center (LRMC) admissions and active surveillance cultures for asymptomatic colonization, restricted to the population of patients who transferred to the U.S. Military Treatment Facility (MTF), June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli c: U.S. Military Treatment Facility (MTF) admissions and active surveillance cultures for asymptomatic colonization, June 2009–May 2012 MDR GNB – multidrug-resistant gram-negative bacilli
FIGURE 2
FIGURE 2
a. Multidrug-resistant (MDR) gram-negative bacilli (GNB) colonization at Landstuhl Regional Medical Center (LRMC) by month of admission, June 2009–May 2012 * p<0.0001 for test of trend over time b. Multidrug-resistant (MDR) gram-negative bacilli (GNB) colonization at U.S. Military Treatment Facilities (MTFs) by month of admission, June 2009–May 2012 * p=0.0042 for test of trend over time; ** p<0.0001 for test of trend over time
FIGURE 2
FIGURE 2
a. Multidrug-resistant (MDR) gram-negative bacilli (GNB) colonization at Landstuhl Regional Medical Center (LRMC) by month of admission, June 2009–May 2012 * p<0.0001 for test of trend over time b. Multidrug-resistant (MDR) gram-negative bacilli (GNB) colonization at U.S. Military Treatment Facilities (MTFs) by month of admission, June 2009–May 2012 * p=0.0042 for test of trend over time; ** p<0.0001 for test of trend over time
FIGURE 3
FIGURE 3
a. Percentage of surveillance cultures with colonizing isolates at Landstuhl Regional Medical Center (LRMC) among patients transferred to U.S. military treatment facilities (MTFs)a by year, June 2009–May 2012 ACB=Acinetobacter calcoaceticus baumannii; MDR=Multidrug resistant a The proportion is the number of LRMC patients with a particular organism among the total patients admitted to LRMC in that year that were transferred to a U.S. MTF Y1=June 2009–May 2010; Y2-June 2010–May 2011; Y3=June 2011–May 2012 b. Percentage of surveillance cultures with colonizing isolates at U.S. military treatment facilities (MTFs)a,b by year, June 2009–May 2012 ACB=Acinetobacter calcoaceticus baumannii; MDR=multidrug resistant a U.S. MTF data were combined for yearly analysis; b The proportion is the number of U.S. MTF patients having a particular organism among the total patients admitted to the U.S. MTFs in that year Y1=June 2009–May 2010; Y2-June 2010–May 2011; Y3=June 2011–May 2012
FIGURE 3
FIGURE 3
a. Percentage of surveillance cultures with colonizing isolates at Landstuhl Regional Medical Center (LRMC) among patients transferred to U.S. military treatment facilities (MTFs)a by year, June 2009–May 2012 ACB=Acinetobacter calcoaceticus baumannii; MDR=Multidrug resistant a The proportion is the number of LRMC patients with a particular organism among the total patients admitted to LRMC in that year that were transferred to a U.S. MTF Y1=June 2009–May 2010; Y2-June 2010–May 2011; Y3=June 2011–May 2012 b. Percentage of surveillance cultures with colonizing isolates at U.S. military treatment facilities (MTFs)a,b by year, June 2009–May 2012 ACB=Acinetobacter calcoaceticus baumannii; MDR=multidrug resistant a U.S. MTF data were combined for yearly analysis; b The proportion is the number of U.S. MTF patients having a particular organism among the total patients admitted to the U.S. MTFs in that year Y1=June 2009–May 2010; Y2-June 2010–May 2011; Y3=June 2011–May 2012
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