• 2021: Treatment Options for Candida auris Webinar
  • Click here to view presentation slides
  • Click here to view presentation recording

• The 2019 AR Threats Report indicates that more than 2.8 million AR infections occur in the U.S. each year, and more than 35,000 people die each year as a result. Additionally, in the U.S., Clostridioides difficile infection caused nearly 223,900 hospitalizations and 12,800 deaths.
• A total of 18 AR bacteria and fungi are classified into one of three categories: urgent, serious, and concerning.
• The 2019 AR Threats Report outlines what has been done and where we need to address gaps in the fight against AR.
• Please visit the CDC’s 2019 AR Threats Report page to read the full report.

The human body is home to trillions of bacteria, viruses and fungi cells. These cells can live on the skin or in the gut. Microorganisms provide a necessary function for human survival.

As the bacteria replicate they can undergo mutations. Sometimes, these mutations help them fight off antibiotics that would normally be effective.  Antimicrobial use has contributed to the development of mutations causing resistance.

The resistant organisms proliferate overtime, becoming the predominant organism type. Sometimes, the resistant organisms pass along the instructions to other organisms, causing more widespread resistance.

MDROs are defined as organisms resistant to at least one or more classes of antimicrobial agents. MDROs present significant risk to patients because of their limited therapeutic options for the infections they cause.

Common MDROs include:

• Candida kruseii
• Carbapenem resistant gram-negative organisms, such as Carbapenem resistant Enterobacteriaceae or Carbapenem resistant Pseudomonas
• Extended spectrum β-lactamase (ESBLs) producing Gram-negative bacteria
• Methicillin Resistant Staphylococcus aureus (MRSA)
• Vancomycin Resistant Enterococci (VRE)

Less Common MDROs with the potential to spread include:

• Candida auris
• Carbapenemase producing gram-negative bacteria
• Vancomycin resistant Staphylococcus aureus

Decreasing antimicrobial resistance requires antimicrobial stewardship and infection prevention efforts. Antimicrobial Stewardship Programs (ASP) reduce antimicrobial resistance by optimizing antimicrobial therapy. ASPs should exist for every practice setting. Programs should be in accordance with the CDC Core Elements for Antimicrobial Stewardship recommendations. More information can be found on the VDH Antimicrobial Stewardship Webpage. Infection prevention is a cornerstone for decreasing the transmission of MDROs. More information can be found on the VDH Infection Prevention Webpage.

In Virginia, a systematic public health response and investigation occurs upon identification of every novel or targeted MDRO. The public health response involves:

1. Promptly detecting the presence of carbapenemases in clinical specimens or pan-resistant isolates;
2. Collecting the least amount of information needed to determine appropriate recommendations based on CDC Containment Strategy Guidance;
3. Verifying appropriate infection control measures (e.g., contact precautions, private room) are implemented by the healthcare facility to stop transmission, and performing onsite assessments of infection prevention practices;
4. Identifying affected patients, determining whether transmission to other patients is occurring or has occurred, and recommending appropriate infection control measures to stop further transmission;
5. Facilitating colonization screenings of high-risk healthcare contacts so that additional infection prevention measures can be put into place; and
6. Continuing to work with the facility or setting on enhanced surveillance and implementation of infection prevention practices. for Novel or Targeted MDROs.

Virginia State and Regional Cumulative Antibiogram

Facility-level antibiograms provide a summary of the percentage of isolates susceptible to a variety of antimicrobial agents within a healthcare facility. They are an important tool for the development of antimicrobial stewardship policies and protocols for empiric antibiotic selection. Some facilities, however - such as small hospitals, skilled nursing facilities and physician practices - do not have enough isolates to create a facility-level antibiogram. These facilities would benefit from a regional and state wide antibiogram to help guide antibiotic selection.

The Virginia Healthcare-Associated Infections Advisory Group, led by the Virginia Department of Health, Health Quality Innovators, and the Virginia Hospital and Healthcare Association, addressed this gap in resources by analyzing data from facility-level antibiograms to create a regional and state-wide antibiogram.

In addition to the benefit to small facilities, the antibiogram also gives an understanding of antimicrobial susceptibility and resistance among bacteria recovered from clinical specimens across Virginia. This allows public health professionals to evaluate temporal trends and geographic patterns to guide infection prevention and antimicrobial stewardship efforts.

2018 Virginia State and Regional Cumulative Antibiogram

2017 Virginia State and Regional Cumulative Antibiogram

Healthcare Provider

CDC Containment Strategy
CDC Infection Prevention for MDROs

Patients

ABCs of Antibiotics
Antibiotic Resistant Patient Fact Sheet

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