Volume 12, Number 3—March 2006
Peer Reviewed Report Available Online Only
Tracking Resistant Organisms: Workshop for Improving State-based Surveillance Programs
Tracking resistant organisms: Workshop for improving state-based surveillance programs
Atlanta, GA, USA
April 28–29, 2005
The Centers for Disease Control and Prevention (CDC) convened Tracking Resistant Organisms: Workshop for Improving State-based Surveillance Programs on April 28–29, 2005, in Atlanta, Georgia. This meeting was organized by the Divisions of Bacterial and Mycotic Diseases and the Divisions of Healthcare Quality Promotion, National Center for Infectious Diseases, CDC, and was cosponsored by the Council of State and Territorial Epidemiologists and the Association of Public Health Laboratories. Attendees included 270 participants from 47 states, including state and local epidemiologists, surveillance officers, antimicrobial resistance and use program coordinators, health educators, and microbiologists. The objective of the 2-day workshop was to assist local public health authorities with planning and implementation of effective antimicrobial drug resistance surveillance systems for use in control of antimicrobial resistance. The following report summarizes the proceedings of the workshop.
Local surveillance systems are essential for tracking and ultimately preventing the spread of drug-resistant Streptococcus pneumoniae (DRSP), Staphylococcus aureus (MRSA), Neisseria gonorrhoeae, and foodborne pathogens. State and local health department officials are most interested in surveillance options that provide valid estimates of their antimicrobial resistance problem. The meeting included plenary and breakout sessions that addressed the following topics: public health impact of drug-resistant organisms; need for accurate surveillance data to monitor resistance trends; considerations in designing an optimal surveillance system; methods, interpretation, and reporting of antimicrobial susceptibility testing; analysis and interpretation of surveillance data; communicating findings with partners; sharing state-level surveillance experiences; and identifying unmet needs of state and local health departments.
An important theme of the workshop was the necessity of multidisciplinary collaboration and communication between epidemiologists, health educators, laboratorians, and the veterinary community. This workshop occurred in conjunction with the Get Smart: Know When Antibiotics Work campaign’s annual conference for health educators to advocate surveillance and health education cooperation.
The surveillance workshop began with reviewing the public health impact of DRSP, MRSA, resistant N. gonorrhoeae, and foodborne pathogens, and the need for accurate surveillance data to monitor resistance trends. S. pneumoniae remains a major cause of respiratory infections in the United States. Monitoring for DRSP is important because its prevalence varies widely by location and because treatment failures for some antimicrobial agents have been documented. The pneumococcal conjugate vaccine and appropriate antimicrobial drug-use programs are effective interventions against resistance.
MRSA is a growing concern to state public health departments. The epidemiology of MRSA disease is changing, with increases in rates of MRSA among hospitalized patients, outbreaks of MRSA in new populations, and the emergence of vancomycin-resistant S. aureus. Because the rate of MRSA varies widely by geographic location, local surveillance data of MRSA are useful. Overall, the goals of MRSA surveillance are to measure the extent of the problem, characterize populations at risk, monitor changes over time, and inform empiric therapy to target and evaluate prevention activities.
Many antimicrobial agents used in human medicine are also used in food animals. Their use in food animals can lead to infections caused by antimicrobial-resistant bacteria in humans. Food animals are an important reservoir of resistant foodborne pathogens, which are transmitted to humans through consumption. Surveillance findings from the National Antimicrobial Resistance Monitoring System (NARMS) for Enteric Bacteria demonstrate increases in multidrug resistance among bacteria that cause intestinal infections and increases in resistance to clinically important antimicrobial agents. Surveillance findings are used to guide control and management efforts. For example, NARMS data showing increasing numbers of fluoroquinolone-resistant Campylobacter infections in humans contributed to a Food and Drug Administration qualitative risk assessment of fluoroquinolone use in poultry and the subsequent removal of these drugs from that market.
The prevalence of infections caused by N. gonorrhoeae resistant to fluoroquinolones and other antimicrobial drugs is increasing. Knowledge of local and national patterns of resistance determines treatment recommendations. Therefore, understanding resistance is critical in treating and controlling gonorrhea. Challenges exist for surveillance of resistance among N. gonorrhoeae because of a decreasing capacity at the local level to perform culture and susceptibility testing. Less invasive nonculture testing, such as nucleic acid amplification tests, has replaced culture as the main mechanism of diagnosis, and few laboratories perform susceptibility testing. Current data from national surveillance do not include resistance data. The 1 system that captures these data is limited to 25 to 30 sites across the country, possibly limiting data representativeness.
Antimicrobial resistance occurs in community, healthcare, and agricultural settings. Decision making and implementing prevention programs in these settings rely upon integration of local surveillance data. Options in methods for data collection include singular or multiple systems that use a combination of active or passive surveillance, sentinel or population-based surveillance, individual case information or aggregated data, and laboratory- and/or provider-based surveillance. Surveillance data should be scientifically valid, meaningful, useful, and feasible. Decisions in designing an optimal surveillance method may rely on available financial and human (laboratory and epidemiology) resources. Benefits and challenges of implementing different methods were identified and discussed by presenters and conference participants through sharing of state-level surveillance experiences.
The goal of the laboratory plenary was to review methods and interpretation of antimicrobial susceptibility testing, standards for testing and interpretation, and importance of strong collaborations with clinical laboratories. This goal was addressed by sessions covering issues and challenges faced by comprehensive surveillance programs including choosing and planning a surveillance system, isolate collection, the effect of outbreaks on surveillance, analysis and dissemination of surveillance information and media training, MRSA, collaboration with veterinary health efforts, strengthening surveillance during an era of bioterrorism threats, and future initiatives in surveillance. The workshop ended with a panel discussion.
Monitoring drug resistance at the local level is important to understand the changing epidemiology of infections caused by resistant organisms, raise awareness of the problem, and develop and measure the effectiveness of prevention and control programs. The 2-day workshop assisted local public health authorities by providing the guidance and necessary tools for planning and implementing effective surveillance systems for emerging antimicrobial drug resistance. For more information, please see: http://www.cdc.gov/drugresistance/community/
Suggested citation for this article:Noggle B, Iwamoto M, Chiller T, Klevens M, Moore MR, Wright J et al. Tracking resistant organisms: Workshop for improving state-based surveillance programs [conference summary]. Emerg Infect Dis [serial on the Internet]. 2006 Mar [date cited]. http://dx.doi.org/10.3201/eid1203.051335