Acinetobacter baumannii image courtesy of CDC
Survey Shows Variance in MDRO Control Practices Continues, Indicating Need for Evidence-based Strategies That Allow for Facility-specific Choice
By Kelly M. Pyrek
A recent update to a SHEA survey last conducted a decade ago indicates continued variance in infection prevention and control-related practices to fight multidrug-resistant organisms( MDROs), including screening for colonization, implementing contact precautions( CP), and time to clearance.
Let’ s quickly compare what has changed in the decade since the last survey.
In the 2016 MDRO survey, 84 percent reported having a formal or informal antibiotic stewardship program at their institution. High-income countries were more likely than middle-income countries to have existing MDRO policies( 61 percent versus 39 percent), and to place patients with MDRO in contact precautions( 56 percent versus 44 percent). Major barriers to preventing MDRO transmission included constrained resources( infrastructure, supplies, and trained staff) and challenges in changing provider behavior.
In the 2026 MDRO survey, 70 percent performed active surveillance for one or more MDROs, but only 16 percent employed preemptive CP. All respondents reported using CP for one or more MDROs. CP were employed more often for infection than colonization. Clearance protocols to discontinue CP were common for MRSA( 97 percent), C. difficile( 95 percent, and vancomycin-resistant enterococci( 82 percent), but uncommon for Gram-negatives. Training and adherence of frontline staff( 70 percent), unavailability of private rooms( 41 percent), and lack of evidence-based strategies to eradicate reservoirs( 34 percent) were the top three identified barriers to MDRO infection control and prevention.
This 2026 survey updates data from several previous studies from the early 2010s( Shenoy and Hsu, et al. and Weiner, et al.) and includes 13 MDROs selected from the CDC’ s 2019 Antibiotic Resistance Threats Report and the most recent update describing the seven most common antimicrobial-resistant pathogens found in healthcare settings. These targeted MDROs included MRSA, vancomycin-resistant enterococci, ESBL, CRE, MDR-PsA, carbapenem-resistant Pseudomonas aeruginosa( CR-PsA), MDR-AB, carbapenem-resistant Acinetobacter baumannii( CRAB), and Clostridioides difficile. The authors note that Candidozyma auris was not explicitly queried owing to a concomitant
C. auris-specific SRN survey.
The 2026 survey revealed that MRSA, C. difficile, and ESBL were the top three MDROs reported as common or very common; CRAB was reported as rare by 93 percent of respondents. Facilities identified C. difficile( 66 percent), CRE( 61 percent)), and ESBL( 41 percent) as the most concerning. Respondents described lack of training / adherence to CP of frontline staff, unavailability of private rooms, and lack of evidence-based strategies to eradicate environmental reservoirs as the top three barriers to effective MDRO infection prevention. Insufficient staffing was ranked in the top three barriers by about 20 percent) of respondents; when insufficient staffing was a barrier, respondents indicated that nurses and cleaning staff were the roles most needed. Let’ s review each control strategy in more detail.
Contact Precautions
Regarding MDRO practices, facilities employed CP more often for infection than colonization when comparing the same organism, and more often for Gram-negative compared to Gram-positive organisms, the researchers found. Survey respondents were statistically more likely to use CP for infection versus colonization for MRSA( P =. 005) and C. difficile( P <. 001). Vancomycin-resistant enterococci trended toward statistical significance( P =. 05). For all Gram-negative organisms, the difference between reported use of CP for infection versus colonization was decidedly smaller and not statistically significant( P >. 05). When CP were instituted, they were more often applied to all patient populations rather than by specific patient population. Of facilities who employ CP for a given MDRO, more than 85 percent reported that they do so for all patients rather than by patient population. Specifically, CP are used for all patients in 86 percent of the 37 sites who use CP for MRSA, 94 percent of the 36 sites who use CP for vancomycin-resistant enterococci, and 100 percent of the 56 sites for CRE. On average across all Gram-negative organisms, among facilities that applied CP, 63 percent reported continuing precautions on all subsequent admissions, although this practice varied by organism. When asked about any additional
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