Abstract
The World Health Organization recommends essential measures to "combat drug resistance", including instituting surveillance "everywhere". Standardized metrics are crucial for reliable surveillance. Studies publish metrics with varying definitions for multi-drug resistant organisms (MDRO). The Society for Healthcare Epidemiology of America (SHEA) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) proposed standardized metrics for MDRO for consistent reporting, identifying high-risk groups, and evaluating interventions. We retrieved 73 studies through PubMed using the search terms "methicillin-resistant Staphylococcus aureus", "MRSA", and "Saudi Arabia". We selected 20 studies that reported MRSA incidence or prevalence in patients and/or percentage among Staphylococcus aureus isolates and evaluated these metrics against the closest matching SHEA/HICPAC metrics. We outlined issues applicable to MRSA metrics such as comparison of risk-unadjusted metrics; their pooling for different hospitals; not accounting for post-discharge infections; non-specification of AST-based, and healthcare and community associated infections' related, standardized metrics by SHEA/HICPAC; and appropriate temporal criteria for nosocomial infections. We elaborated salient features of reviewed metrics versus their SHEA/HICPAC complements. Terminology and definitions of reviewed metrics differed from SHEA/HICPAC counterparts. Some did not satisfy the epidemiological or statistical criteria for their reported category; e.g. prevalence indicators were classified as incidence and vice versa. SHEA/HICPAC metrics would be useful for future studies. Our results show an imminent need for an international consensus on fundamental MDRO surveillance metrics; illustrate surveillance scenarios requiring standardized metrics; identify some indicators from Saudi studies supplementing SHEA/HICPAC metrics; and underscore SHEA/HICPAC's advice for avoiding comparison of risk-unadjusted metrics between hospitals.
Highlights
The World Health Organization recommends essential measures to “combat drug resistance”, including instituting surveillance “everywhere”
One study reported prevalence of “nosocomial” or “hospital-acquired” infections and colonizations [10]. We considered it as hospital-onset incidence rate, as this Society for Healthcare Epidemiology of America (SHEA)/Healthcare Infection Control Practices Advisory Committee (HICPAC) metric includes infections and colonizations acquired during current admission
We could only express our views about a few aspects of the metrics reported by each reviewed study and admit that an in-depth discourse on this perplexing subject is beyond our purview
Summary
The World Health Organization recommends essential measures to “combat drug resistance”, including instituting surveillance “everywhere”. Studies publish metrics with varying definitions for multi-drug resistant organisms (MDRO). The Society for Healthcare Epidemiology of America (SHEA) and the Healthcare Infection Control Practices Advisory Committee (HICPAC) proposed standardized metrics for MDRO for consistent reporting, identifying high-risk groups, and evaluating interventions. Results: We outlined issues applicable to MRSA metrics such as comparison of risk-unadjusted metrics; their pooling for different hospitals; not accounting for post-discharge infections; non-specification of AST-based, and healthcare and community associated infections’ related, standardized metrics by SHEA/HICPAC; and appropriate temporal criteria for nosocomial infections. Published studies employ varying terms, definitions, and metrics for infections detected in healthcare facilities, such as hospital-acquired [3], healthcare-acquired [4], community-acquired [5], and nosocomial [2] infections, etc. Committee (HICPAC) recommended standardized metrics for multi-drug resistant organisms (MDRO) in healthcare settings for consistent usage [2]. MDRO infection is considered “nosocomial” if there is no evidence that infection was incubating or present on admission and it is detected after a specified time cutoff [2], healthcareassociated if attributable to current or recent healthcare delivery, medical devices, or procedures [2], or community-associated without known
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