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924 The Multidrug-resistant Organism Repository and Surveillance Network (MRSN): The Army's Response to the Antibiotic Resistance Crisis

Sunday, March 21, 2010
Grand Hall (Hyatt Regency Atlanta)
Emil Lesho , Walter Reed Army Institute of Research, Silver Spring, MD
David W. Craft , Walter Reed Army Institute of Research, Silver Spring, MD
Kent E. Kester , Walter Reed Army Institute of Research, Silver Spring, MD
Maryanne T. Vahey , Walter Reed Army Institute of Research, Silver Spring, MD
Benjamin Kirkup , Walter Reed Army Institute of Research, Silver Spring, MD
Amy Summers , Walter Reed Army Institute of Research, Silver Spring, MD
Paige Waterman , Walter Reed Army Institute of Research, Silver Spring, MD
Robert Bowden , Walter Reed Army Institute of Research, Silver Spring, MD
Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated information are essential to understanding the challenges, successes and failures the Army’s healthcare system faces in controlling the current epidemic of infections with these bacteria.  

Objective: Begin collection of these pathogens along the entire evacuation chain to enable spatial analysis and epidemiologic profiling necessary to determine attributable origins, patterns of spread, and mechanisms of resistance.

Methods: In June 2009, the Army Medical Command authorized the Walter Reed Army Institute of Research to establish the MRSN, consisting of a microbiology laboratory, repository and an Army-wide surveillance network.  Army hospitals submit all MDRO encountered during healthcare delivery and active surveillance to the network repository, along with the associated clinical-demographic information.  The repository determines their genetic relatedness, performs extended phenotypic and phylogenetic analyses, and preserves them indefinitely.  Analogous to successful civilian programs, monitoring and feedback of infection control components along with site visits comprise key tenets of the MRSN.

Results: Site assistance visits to stateside and overseas facilities were conducted.  By October 2009, over 800 MDRO from three major military referral centers were collected, centralized and are currently undergoing clonal analysis.  The MRSN also assisted in one outbreak investigation. The first of the monthly reports to healthcare policy makers and infection preventionists will be issued in December 2009.  Ultimately, facility specific, regional and global antibiograms along with other epidemiologic data will be made available on a secure web-enabled database. Archived isolates will be available to investigators.

Conclusions: System-wide active surveillance, standardized characterization and centralized archiving of these organisms may enhance infection prevention and control efforts and earlier detection of outbreaks. Opportunities for future collaboration with HHS and the VA will be discussed.