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562 The Multidrug-Resistance Organism Repository and Surveillance Network: Program Announcement and Early Results

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Emil Lesho , Walter Reed Army Institute of Research, Silver Spring, MD
Paige Waterman , Walter Reed Army Institute of Research, Silver Spring, MD
Amy Summers , Walter Reed Army Institute of Research, Silver Spring, MD
Patrick McGann , Walter Reed Army Institute of Research, Silver Spring, MD
Yoon Kwak , Walter Reed Army Institute of Research, Silver Spring, MD
Ligia Flores , Walter Reed Army Institute of Research, Silver Spring, MD
Bejamin C Kirkup, Jr , Walter Reed Army Institute of Research, Silver Spring, MD
Dan Zurawski , Walter Reed Army Institute of Research, Silver Spring, MD
Todd Gleeson , National Naval Medical Center, Bethesda, MD
Timothy Whitman , National Naval Medical Center, Bethesda, MD
Regina VanBrakle , Walter Reed Army Medical Center, Washington, DC
Britta Babel , National Naval Medical Center, Bethesda, MD
Yuanzheng Si , Walter Reed Army Institute of Research, Silver Spring, MD
Patricia Dempsey , Womack Army Medical Center, Ft. Bragg, NC
Thomas Palys , Landstuhl Regional Medical Center, Landstuhl, Germany
Kurt Jerke , Landstuhl Regional Medical Center, Landstuhl, Germany
Rachel Stonesifer , Walter Reed Army Institute of Research, Silver Spring, MD
Miguel Arroyo-Cazurro , Combat Support Hospital, Iraq, Iraq
Glenn Wortmann , Walter Reed Army Medical Center, Washington, DC
David Craft , Walter Reed Army Institute of Research, Silver Spring, MD
Background: In response to increasing rates of infections with multidrug- resistant organisms (MDRO) (particularly Gram-negative MDRO) in the U.S. military health system, the Multidrug-resistant organism Repository and Surveillance Network (MRSN) was launched in July 2009.

Objective: Collect and characterize MDRO across the military healthcare enterprise to inform and enhance clinical practice, policy, and infection control.

Methods: Under a performance improvement infection control mandate, Army hospitals, including those in war zones, submit targeted MDRO as they are isolated from infections or surveillance activities to the MRSN. There, characterization includes phenotypic identity and susceptibility confirmation on three different diagnostic analyzers, pulsed-field gel electrophoresis (PFGE) and real-time polymerase chain reaction (PCR) for emergent NDM-1 and VIM-type metallo-β-lactamase-producing (MBL) genes, whole genome optical mapping, and archival cryopreservation. Regular reports, such as monthly antibiograms, and event-driven reports, such as strain relatedness among patients and locations, are sent to clinicians, infection control teams, and policy makers to guide empiric therapy and enhance outbreak or emerging pathogen detection.

Results: Currently, 7 hospitals (including 2 in war zones) were enrolled and participate. During the first year, 3164 isolates were collected and 895 were fully characterized. No MBL producing genes were detected to date.  Assistance with outbreak investigation was requested 8 times from 4 facilities.  Turn-around time from the request by the facility for laboratory assistance to the feedback of actionable information ranged from 3.5 days for hospitals in the National Capital area to 13 days for the hospital ship U.S. Comfort stationed off the coast of Haiti. Nosocomial transmission of a clone involved in a fatal health care associated infection was successfully interrupted, and surveillance policy at the facility was changed based on analysis by and feedback from the MRSN.  Requests to provide isolates for basic research or drug development were frequent.

Conclusions: Although nascent, the MRSN demonstrated its usefulness, unburdening clinical labs of outbreak investigation, informing clinicians, influencing policy and reducing nosocomial infections.  As the program matures, the throughput and surveillance footprint will increase. The MRSN collaborates with the Centers for Disease Control and Prevention (CDC), and all of its PFGE protocols are identical to the CDC’s for improved data comparison and sharing.  The MRSN is adding PCR screening of methicillin resistant Staphylococcus aureus isolates for the antiseptic resistance genes qacA and qacB to its routine characterization profile.