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While support for antibiotic stewardship programs increased across hospitals since 2013, surveillance for multi-drug resistant organisms stayed flat or ticked down, a small survey of healthcare facilities in the Society for Healthcare Epidemiology of America (SHEA) Research Network found.

Nearly all healthcare facilities, the majority of which were acute care hospitals, had antibiotic stewardship programs (95% in 2017 compared with 83% in 2013), and increased their support for these program medical directors and steward pharmacists, reported Kathleen Chiotos, MD, of Children's Hospital of Philadelphia, and colleagues.

However, surveillance for methicillin-resistant Staphylococcus aureus (MRSA) declined versus 2013, the authors wrote in .

They noted that both infection prevention and control and antimicrobial stewardship programs should be the main part of a multifaceted approach to prevention of healthcare-associated infections and infections due to antibiotic-resistant organisms.

The researchers invited all 132 facilities in the SHEA Research Network, "a consortium of hospitals conducting collaborative research projects in healthcare epidemiology and antibiotic stewardship," to participate in the survey. In total, the team received 64 surveys from 47 U.S. hospitals and 17 international healthcare facilities from 11 countries. Nearly all healthcare facilities were acute care hospitals, and 45 provided care for children. About 30% participated in both the 2013 and 2018 surveys.

While MRSA was still the most common multi-drug organism where surveillance was reported, surveillance dropped from 90% of surveyed facilities in 2013 to 69% of surveyed facilities in 2018. The authors also noted that surveillance for multi-drug resistant gram-negative organisms stayed mostly flat from 2013 to 2018 (28 of 61 facilities vs 32 of 64 facilities, respectively). Half of healthcare facilities performed surveillance for carbapenem-resistant Enterobacteriaceae (CRE), which was not measured in 2013, the authors noted.

"This finding may reflect a response to surveillance recommendations made in the 2015 [CDC] CRE toolkit, coupled with data demonstrating no significant reduction in MRSA transmission with active surveillance and use of contact precautions," Chiotos and co-authors wrote.

They reported gains specifically in the monitoring of environmental cleaning effectiveness (98% of facilities in 2018 vs 80% in 2013), though a minority of facilities used ultraviolet light and hydrogen peroxide mist/vapor modalities, the team noted.

In terms of antibiotic stewardship programs, 78% of facilities provided financial support for physician medical directors versus 52% in 2013. Similar numbers were seen when examining financial support for stewardship pharmacists (85% vs 54%, respectively). However, these programs also reported challenges -- with around half citing lack of funding and staff, and more than half saying they had "insufficient information technology and/or data analyst support."

The authors encouraged hospital-level support for infection prevention and control programs and antibiotic stewardship programs, as well as funding for epidemiology research at the government level.

"Our survey demonstrates the increasingly complex role of the healthcare epidemiologist and [antibiotic stewardship program], including growing regulatory demands, burgeoning antibiotic resistance threats, and integration of emerging technologies into existing workflows; however, most facilities do not anticipate receiving additional resources to meet these demands," the researchers concluded.