Skip to main content Accessibility help
×
Home

Antimicrobial Proficiency Testing of National Nosocomial Infections Surveillance System Hospital Laboratories

Published online by Cambridge University Press:  02 January 2015

Jeffrey C. Hageman
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Scott K. Fridkin
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Jasmine M. Mohammed
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Christine D. Steward
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Robert P. Gaynes
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Fred C. Tenover
Affiliation:
Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

Abstract

Objective:

The National Nosocomial Infections Surveillance (NNIS) System personnel report trends in antimicrobial-resistant pathogens. To validate select antimicrobial susceptibility testing results and to identify test methods that tend to produce errors, we conducted proficiency testing among NNIS System hospital laboratories.

Setting:

NNIS System hospital laboratories in the United States.

Methods:

Each laboratory received five organisms (ie, an imipenem-resistant Serratia marcescens, an oxacillin-resistant Staphylococcus aureus, a vancomycin-resistant Enterococcus faecalis, a vancomycin-intermediate Staphylococcus epidermidis, and an extended-spectrum beta-lactamase (ESβL)-producing Klebsiella pneumoniae). Testing results were compared with reference testing results from the Centers for Disease Control and Prevention.

Results:

Of 138 laboratories testing imipenem against the Serratia marcescens strain, 110 (80%) correctly reported minimum inhibitory concentrations (MICs) or zone sizes in the resistant range. All 193 participating laboratories correctly reported the Staphylococcus aureus strain as oxacillin resistant. Of the 193 laboratories, 169 (88%) reported correct MICs or zone sizes for the vancomycin-resistant Enterococcus faecalis. One hundred sixty-two (84%) of 193 laboratories demonstrated the ability to detect a vancomycin-intermediate strain of Staphylococcus epidermidis; however, disk diffusion performed poorly when testing both staphylococci and enterococci with vancomycin. Although laboratory personnel correctly reported nonsusceptible extended-spectrum cephalosporins and aztreonam results for K. pneumoniae, only 98 (51%) of 193 correctly reported this organism as an ESβL producer.

Conclusion:

Overall, NNIS System hospital laboratory personnel detected most emerging resistance patterns. Disk diffusion continues to be unreliable for vancomycin testing of staphylococci and must be used cautiously for enterococci. Further education on the processing of ESβL-producing organisms is warranted.

Type
Orginal Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

Access options

Get access to the full version of this content by using one of the access options below.

References

1.Schwartz, B, Bell, D, Hughes, JM. Preventing the emergence of antimicrobial resistance: a call for action by clinicians, public health officials, and patients. JAMA 1997;278:944945.CrossRefGoogle Scholar
2.McGowan, JE, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin North Am 1997;11:297311.CrossRefGoogle ScholarPubMed
3.Tenover, FC, Tokars, J, Swenson, J, Paul, S, Spitalny, K, Jarvis, WR. Ability of clinical laboratories to detect antimicrobial agent-resistant enterococci. J Clin Microbiol 1993;31:16951699.Google ScholarPubMed
4.Tenover, FC, Lancaster, MV, Hill, BC, et al.Characterization of staphylococci with reduced susceptibilities to vancomycin and other gly-copeptides. J Clin Microbiol 1998;36:10201027.Google Scholar
5.Tenover, FC, Swenson, JM, O'Hara, CM, Stocker, SA. Ability of commercial and reference antimicrobial susceptibility testing methods to detect vancomycin resistance in enterococci. J Clin Microbiol 1995;33:15241527.Google ScholarPubMed
6.Tenover, FC, Mohammed, MJ, Stelling, J, O'Brien, T, Williams, R. Ability of laboratories to detect emerging antimicrobial resistance: proficiency testing and quality control results from the World Health Organization's external quality assurance system for antimicrobial susceptibility testing. J Clin Microbiol 2001;39:241250.CrossRefGoogle ScholarPubMed
7.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-April 2000, issued June 2000. Am J Infect Control 2000;28:429448.CrossRefGoogle ScholarPubMed
8.Fridkin, SK. Increasing prevalence of antimicrobial resistance in intensive care units. Crit Care Med 2001;29:N64N68.CrossRefGoogle ScholarPubMed
9.Centers for Disease Control and Prevention. Laboratory capacity to detect antimicrobial resistance, 1998. MMWR 2001;48:11671171.Google Scholar
10.Tenover, FC, Mohammed, MJ, Gorton, TS, Dembek, ZF. Detection and reporting of organisms producing extended-spectrum beta-lacta-mases: survey of laboratories in Connecticut. J Clin Microbiol 1999;37:40654070.Google Scholar
11.Steward, CD, Wallace, D, Hubert, SK, et al.Ability of laboratories to detect emerging antimicrobial resistance in nosocomial pathogens: a survey of Project ICARE laboratories. Diagn Microbiol Infed Dis 2000;38:5967CrossRefGoogle ScholarPubMed
12.Deikema, DJ, Pfaller, MASmayevsky, J, et al.Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific Region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001;32:S114S132.CrossRefGoogle Scholar
13.Sahm, DF, Marsilio, MK, Piazza, G. Antimicrobial resistance in key bloodstream bacterial isolates: electronic surveillance with the Surveillance Network Database-USA Clin Infect Dis 1999;29:259263.CrossRefGoogle ScholarPubMed
14.Edmond, MB, Wallace, SE, McClish, DK, Pfaller, MA, Jones, RN, Wenzel, RP. Nosocomial bloodstream infections in United States hospitals: a three-year analysis. Clin Infect Dis 1999;29:239244.CrossRefGoogle ScholarPubMed
15.Swenson, JM, Clark, NC, Sahm, DF, et al.Molecular characterization and multilaboratory evaluation of Enterococcus faecalis ATCC 51299 for quality control of screening tests for vancomycin and high-level aminoglycoside resistance in enterococci. J Clin Microbiol 1995;33:30193021.Google ScholarPubMed
16.Rosenberg, J, Tenover, FC, Wong, J, Jarvis, W, Vugia, DJ. Are clinical laboratories in California accurately reporting vancomycin-resistant enterococci? J Clin Microbiol 1997;35:25262530.Google ScholarPubMed
17.Yigit, H, Steward, CD, Biddle, JW, Tenover, FC. Characterization of β-lac-tamases and porin changes in carbapenem-resistant isolates of Klebsiella pneumoniae and Serratia marcescens. Presented at the 99th General Meeting of the American Society for Microbiology; May 30-June 3, 1999; Washington, DC. Abstract A-61.Google Scholar
18.Garrett, DO, Jochimsen, E, Murfitt, K, et al.The emergence of decreased susceptibility to vancomycin in Staphylococcus epidermidis. Infect Control Hosp Epidemiol 1999;20:167170.CrossRefGoogle ScholarPubMed
19.Rasheed, JK, Tenover, FC, Anderson, GJ, et al.Characterization of extended-spectrum beta-lactamase reference strain, Klebsiella pneumoniae K6 (ATCC 700603), which produces the novel enzyme SHV-18. Antimicrob Agents Chemother 2000;44:23822388.CrossRefGoogle Scholar
20.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 4th ed. Wayne, PANational Committee for Clinical Laboratory Standards; 1997. Approved standard M7-A4.Google ScholarPubMed
21.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, 6th ed. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M2-A6.Google Scholar
22.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999. Approved standard M100-S9.Google ScholarPubMed
23.Richards, C, Emori, TG, Edwards, J, et al.Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. Am J Infect Control 2001;29:400403.CrossRefGoogle ScholarPubMed
24.Jones, RN. Method preferences and test accuracy of antimicrobial susceptibility testing. Arch Pathol Lab Med 2001;125:12851289.Google ScholarPubMed
25.Smith, TL, Pearson, ML, Wilcox, KR, et al.Emergence of vancomycin resistance in Staphylococcus aureus: Glycopeptide-Intermediate Staphylococcus aureus Working Group. N Engl J Med 1999;340:493501.CrossRefGoogle ScholarPubMed
26.Centers for Disease Control and Prevention. Staphylococcus aureus with reduced susceptibility to vancomycin: Illinois, 1999. MMWR 2000;48:11651167.Google Scholar
27.Hageman, JC, Pegues, DAJepson, C, et al.Vancomycin-intermediate Staphylococcus aureus in a home healthcare patient. Emerg Infect Dis 2001;7:10231025.CrossRefGoogle Scholar
28.Fridkin, SKVancomycin-intermediate and -resistant Staphylococcus aureus: what the infectious diseases specialist needs to know. Clin Infect Dis 2001;32:108115.Google Scholar
29.Centers for Disease Control and Prevention. Interim guidelines for prevention and control of staphylococcal infection associated with reduced susceptibility to vancomycin. MMWR 1997;46:626-628, 635.Google ScholarPubMed
30.Tenover, FC, Biddle, JW, Lancaster, MV. Increasing resistance to vancomycin and other glycopeptides in Staphylococcus aureus. Emerg Infect Dis 2001;7:327332.CrossRefGoogle ScholarPubMed
31.Marlowe, EM, Cohen, MD, Hindler, JF, Ward, KW, Bruckner, DAPractical strategies for detecting and confirming vancomycin-intermediate Staphylococcus aureus: a tertiary-care hospital laboratory's experience. J Clin Microbiol 2001;39:26372639.CrossRefGoogle ScholarPubMed
32.Fridkin, SK, Gaynes, RP. Antimicrobial resistance in intensive care units. Clin Chest Med 1999;20:303316.CrossRefGoogle ScholarPubMed
33.Grist, R. External factors affecting imipenem performance in dried microdilution MIC plates. J Clin Microbiol 1992;30:535536.Google ScholarPubMed
34.White, RL, Kays, MB, Friedrich, LV, Brown, EW, Koonce, JR. Pseudoresistance of Pseudomonas aeruginosa resulting from degradation of imipenem in an automated susceptibility testing system with predried panels. J Clin Microbiol 1991;29:398400.Google Scholar
35.Carmeli, Y, Eichelberger, K, Soja, D, et al.Failure of quality control measures to prevent reporting of false resistance to imipenem, resulting in a pseudo-outbreak of imipenem-resistant Pseudomonas aeruginosa. J Clin Microbiol 1998;36:595597.Google Scholar
36.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 1998. Approved standard M100-S8.Google ScholarPubMed

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 0
Total number of PDF views: 8 *
View data table for this chart

* Views captured on Cambridge Core between September 2016 - 20th January 2021. This data will be updated every 24 hours.

Hostname: page-component-76cb886bbf-kfxvk Total loading time: 0.32 Render date: 2021-01-20T04:43:49.719Z Query parameters: { "hasAccess": "0", "openAccess": "0", "isLogged": "0", "lang": "en" } Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false }

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Antimicrobial Proficiency Testing of National Nosocomial Infections Surveillance System Hospital Laboratories
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Antimicrobial Proficiency Testing of National Nosocomial Infections Surveillance System Hospital Laboratories
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Antimicrobial Proficiency Testing of National Nosocomial Infections Surveillance System Hospital Laboratories
Available formats
×
×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *