Statewide Surveillance for Antibiotic-Resistant Bacteria -- New
Jersey, 1992-1994
The increasing occurrence of infection with
antibiotic-resistant microorganisms and other emerging infectious
diseases has required the development of flexible and timely
surveillance systems for monitoring these problems (1,2). To
determine the extent of antibiotic resistance in New Jersey, in
1991 the New Jersey State Department of Health (NJSDOH) initiated
a hospital laboratory isolate-based surveillance system for
antimicrobial-resistant bacteria. This report describes the
surveillance system and summarizes findings during 1992-1994 for
vancomycin-resistant enterococci (VRE) -- the most rapidly
increasing
antibiotic-resistant bacteria reported by New Jersey hospitals.
The surveillance system includes the 95 acute-care hospitals
licensed by the state of New Jersey. Organisms targeted for
surveillance include gram-positive cocci resistant to vancomycin,
including VRE; methicillin-resistant Staphylococcus aureus (MRSA);
gram-negative rod-shaped bacteria (GNRs) resistant to imipenem;
GNRs resistant to amikacin; and pneumococcal and other
streptococcal isolates resistant to penicillin. Hospitals submit to
NJSDOH monthly a surveillance report form, which includes the
number of in-patient bloodstream isolates of these organisms and
MRSA isolates from any body site. The New Jersey Administrative
Code, which addresses communicable diseases, and state hospital
licensure standards were modified in 1990 to require hospitals to
submit these data to NJSDOH. Hospitals are contacted by the
surveillance system coordinator to ensure monthly reporting; since
the surveillance system was initiated, all hospitals have submitted
monthly reports (3).
During 1992-1994, a total of 5916 (81%) bloodstream isolates
reported to this system were MRSA. Of the 1398 non-MRSA bloodstream
isolates, 663 (47%) were VRE. During this period, both the number
of hospitals reporting VRE blood isolates and the number of VRE
isolates increased steadily: in 1992, 33 hospitals reported 99
isolates, while in 1994, 54 hospitals reported 278 isolates
Figure_1. Most of the monthly reports (73%) represent only one
reported isolate per hospital. In 1992, hospitals in 13 of the 21
counties reported VRE isolates, compared with 20 of 21 counties in
1994.
Reported by: SM Paul, MD, L Finelli, DrPH, G Crane, MPH, KC
Spitalny, MD, State Epidemiologist, New Jersey State Dept of
Health. National Center for Infectious Diseases, CDC.
Editorial Note
Editorial Note: The recent national emphasis on emerging infectious
diseases has underscored the problem of antibiotic resistance
involving a variety of nosocomial and community-acquired infections
and has focused attention on the importance of microbiology
laboratories as sources of surveillance information for antibiotic
resistance (1,2). For example, in New Jersey, the increase in both
the number of VRE blood isolates and the number of hospitals
reporting VRE blood isolates from 1992 through 1994 suggests the
emergence of the problem of VRE in that state. Careful monitoring
of such trends in antibiotic resistance in enterococci and other
organisms assists clinicians in selecting antibiotics for their
patients and public health agencies in the development and
implementation of prevention efforts.
In New Jersey, laboratory-based surveillance for VRE and other
antibiotic-resistant isolates has been developed through
collaboration between the NJSDOH, hospitals, and infectious disease
professionals in the state and because of modification of reporting
regulations. The New Jersey system uses data that are routinely
collected and collated by hospital laboratories and requires few
additional resources. Because this surveillance system is
isolate-based, it does not directly measure changes in the rate of
infection in persons, and NJSDOH has used this system primarily for
sentinel purposes to guide further investigation. For example,
early detection and geographic tracking of VRE in New Jersey
through this system have facilitated collaborative efforts
involving public and private sector and academic organizations to
evaluate risk factors for VRE, treatment options, VRE in vitro
susceptibility to antimicrobial agents before clinical trials, and
the effectiveness of infection-control practices (4-7). These
efforts have, in turn, enabled the NJSDOH to collaborate with
professional organizations (the Infectious Diseases Society of New
Jersey and the New Jersey chapters of the Association for
Professionals in Infection Control and Epidemiology) to develop
recommendations to prevent VRE transmission and have provided a
source of bacterial isolates to assist in research efforts to
develop effective antimicrobial agents against VRE.
References
Institute of Medicine. Emerging infections: microbial threats to
health in the United States. Washington, DC: National Academy
Press, 1992.
CDC. Addressing emerging infectious disease threats to health:
a prevention strategy for the United States. Atlanta, Georgia: US
Department of Health and Human Services, Public Health Service,
1994.
Paul SM, Finelli L, Crance GL, Spitalny KC. A statewide
surveillance system for antimicrobial resistant bacteria -- New
Jersey. Infect Control Hosp Epidemiol 1995;16 (in press).
Paul SM, Silber JL, Crane G, Kupersmit A, Spitalny K.
Vancomycin-resistant enterococcal (VRE) blood isolates in New
Jersey (NJ) hospitals: an 18 month study. In: Proceedings of the
fourth annual meeting of the Society for Hospital Epidemiology of
America. West Deptford, New Jersey: Society for Hospital
Epidemiology of America, 1994.
Paul SM, Noveck H, Silber JL, Wartenberg D, Crane G, Spitalny K.
A statewide study of patient risk factors for vancomycin-resistant
enterococcal bacteremia. In: Proceedings of the fourth annual
meeting of the Society for Hospital Epidemiology of America. West
Deptford, New Jersey: Society for Hospital Epidemiology of America,
1994.
Silber JL, Patel M, Paul SM, Kostman JR. Statewide surveillance
of isolates of vancomycin-resistant gram-positive cocci: genotyping
of vancomycin resistance and activity of Quinupristin/Dalfopristin
(RP59500) and other antimicrobials. In: Proceedings of the 34th
Annual Interscience Conference on Antimicrobial Agents and
Chemotherapy. Washington, DC: American Society for Microbiology,
1994.
Cronan J, Silber J, Schwarz G, Paul SM. Infection control
practices and the prevalence of vancomycin-resistant enterococci
(VRE) in New Jersey hospitals. In: Proceedings of the 34th Annual
Interscience Conference on Antimicrobial Agents and Chemotherapy.
Washington, DC: American Society for Microbiology, 1994.
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