BACKGROUND: CDC’s National Healthcare Safety Network (NHSN) collects surveillance data on healthcare-associated infections (HAIs) from almost all acute care, long-term acute care, and inpatient rehabilitation facilities in the U.S. The Multidrug-resistant Organism/Clostridium difficile (MDRO/CDI) Module of NHSN enables facilities to report laboratory-identified events (LabID Events) based on positive microbiologic test results for specified drug-resistant organisms such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococcus spp. (VRE). In 2013, the Centers for Medicare & Medicaid Services (CMS) Inpatient Quality Reporting program introduced a requirement for participating facilities to report positive MRSA blood and CDI specimens to NHSN’s MDRO/CDI Module. While national and state MRSA and CDI data are published annually in CDC’s National and State HAI Progress Report, the extent of NHSN surveillance in healthcare facilities of the non-required organisms has not been previously described.
METHODS: We analyzed MDRO/CDI Module data for the two most recent years for which data are available, 2015 and 2016, to identify the number, geographic location, and types of healthcare facilities performing surveillance of VRE, extended-spectrum cephalosporin-resistant (ESC-R) Klebsiella spp., CRE, methicillin-sensitive S. aureus (MSSA), and MDR-Acinetobacter spp. LabID events were categorized as healthcare facility-onset (HO; > 3 days after patient admission) or community-onset (CO; ≤ 3 days after patient admission). National HO incidence rates and CO prevalence rates, as well as percentile distributions, were calculated for each MDRO.
RESULTS: In 2015, there were 631 facilities reporting at least 1 month of in-plan VRE data, 594 facilities reporting CRE, 142 facilities reporting MDR Acinetobacter spp., 129 facilities reporting ESC-R Klebsiella spp., and 88 facilities reporting MSSA. The number of facilities reporting data varied by facility type and state. National incidence and prevalence rates were calculated for each organism using the appropriate denominator (i.e., patient days and admissions). Updated results using 2016 data will be available to present at the conference.
CONCLUSIONS: Among the non-CMS required MDROs, VRE and CRE were the organisms most frequently brought under surveillance by facilities, likely due to state HAI reporting mandates. Fewer facilities reported LabID event data for ESC-R Klebsiella spp., MSSA, and MDR-Acinetobacter spp. Additional analyses, such as regression modeling, can be performed to establish a risk-adjusted measure for those organisms where sufficient data exist. Providing national benchmarks for the non-required organisms would allow for facility/state comparisons to national data, aid in identifying opportunities for prevention, and encourage additional reporting into the MDRO/CDI Module.