The Veterans Health Administration has published a series of articles in the February issue of Infection Control & Hospital Epidemiology that identify gaps in existing knowledge about multidrug-resistant organisms (MDROs). The administration worked with experts in four areas: transmission dynamics, antimicrobial stewardship, the microbiome and special populations. The research details the role these factors play in infection-prevention efforts and strategies to improve each area.

The article on transmission dynamics discusses resistant pathogens spread via human hands and environmental surfaces and that the need to disrupt this transmission is essential to controlling MDROs. The researchers outline the keystones of transmission prevention and opportunities for further investigation in hand hygiene, active surveillance, isolation measures and enhanced environmental-cleaning interventions.

The antimicrobial stewardship article focuses on strategies to improve the use of antibiotics and antifungals to reduce antibiotic resistance and improve clinical outcomes for patients. According to the authors, the antibiotic stewardship strategies in inpatient and outpatient settings must focus on: optimizing structures for teams that lead these efforts; refining the activities implemented; determining dosing and duration of use; and using metrics to predict changes in resistance.

The microbiome article zeroes in on how it influences MDRO infections in health care settings. The researchers say there may be ways to manipulate the human microbiome to eradicate or prevent colonization by resistant pathogens. This article notes the importance of establishing a framework for microbiome research and prioritizing certain study designs, such as longitudinal studies and randomized controlled trials. It also recommends further study of the efficacy of fecal microbiota transplantation, and of additional microbiota research beyond the gastrointestinal tract.

The authors of the special populations article say that protocols commonly used to reduce the risk of health care-associated infections and MDROs in the hospital setting may be inappropriate or inadequate for health care personnel and patients in other settings. The authors outline specific care settings that should be prioritized, including long-term care, spinal cord injury/disorder departments, rehabilitation, mental health care, ambulatory care, and home-based care.

"Multidrug-resistant organisms cause infections that are very difficult to treat,” says Eli Perencevich, M.D., MS, director of the Center for Comprehensive Access & Delivery Research and Evaluation at the Iowa City (Iowa) VA Health Care System. “This threat goes beyond the medical community. It is a public health crisis waiting to happen. The Veterans Health Administration is uniquely positioned to be a leader in this area and has the ability to make a real impact. These four articles will help to set the research agenda and provide a starting point for other health care systems to implement, or improve upon, in their own approaches."