Wisconsin DHS Health Alert #58: Increasing Cases of Multidrug-Resistant Organisms in Wisconsin
Preventing and Controlling Candida auris and other Multidrug-Resistant Organisms in Wisconsin: Recommendations for Health Care Providers
Bureau of Communicable Diseases
Friday, February 9, 2024
Key points
- Wisconsin cases of reportable multidrug-resistant organisms (MDROs) increased in 2023 including in public health regions where there was previously little to no MDRO activity detected.
- Most notably, Candida auris (C. auris) cases have more than tripled from 2022 (5 cases) to 2023 (21 cases).
- The Wisconsin Department of Health Services (DHS) encourages health care providers and facilities to remain diligent in their prevention and control efforts by following infection prevention best practices.
Background
MDROs are an ongoing threat to public health. The potential for rapid spread in health care settings, as well as the difficulty in treating infections caused by these organisms, underscore the need for health care facilities to be prepared to respond to the presence of MDROs. Those at highest risk of acquiring an MDRO include patients and residents receiving health care, including those with:
- Indwelling medical devices and/or lines.
- Presence or history of chronic wounds.
- History of residing in congregate living settings.
- History of out-of-state or international health care.
- History of frequent surgeries or procedures.
- Frequent or prolonged stays in hospitals or long-term care facilities.
- Underlying chronic medical conditions.
Systemic, statewide surveillance is an essential part in controlling the spread of these organisms. In July 2022, Wisconsin expanded MDRO reporting requirements to include, carbapenemase-producing carbapenem-resistant Acinetobacter baumannii (CP-CRAB), carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE), carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA), and C. auris as category II reportable conditions. Vancomycin-intermediate Staphylococcus aureus (VISA) has been a category II reportable condition since 2007. These organisms align with the CDC (Centers for Disease Control and Prevention) targeted MRDOs.
MDRO activity
Wisconsin is seeing increasing activity of reportable MDROs. Notable increases include C. auris cases, which more than tripled from 2022 (5 cases) to 2023 (21 cases). Sixteen of the 21 cases of C. auris reported in 2023 were detected in the Southeastern public health region of the state. C. auris cases were also identified in the Southern and Northeastern regions in late 2023, both regions with previously little to no C. auris activity detected.
Reportable MDRO cases* by year, 2019–2023
| MDRO Type |
2019 |
2020 |
2021 |
2022 |
2023 |
| CP-CRAB |
46 |
41 |
153 |
112 |
153 |
| CP-CRE |
45 |
30 |
42 |
45 |
37 |
| CP-CRPA |
0 |
2 |
2 |
4 |
3 |
| C. auris |
0 |
0 |
1 |
5 |
21 |
| VISA |
3 |
1 |
1 |
2 |
4 |
Data source: Wisconsin Electronic Disease Surveillance System (WEDSS)
*Cases are deduplicated and include both clinical and screening isolates.
Case counts for all reportable MDROs are available on the DHS MDRO webpage. In addition, case counts for C. auris are also available on the DHS C. auris webpage.
Recommendations for health care providers
DHS recommends Wisconsin health care providers continue to follow infection prevention best practices in order to prevent and control the spread of MDROs.
-
Use appropriate precautions when working with patients and residents. All health care facilities must use standard precautions for all patient or resident care encounters.
- Hospitals are strongly encouraged to use contact precautions in addition to standard precautions when caring for patients who are colonized or infected with a targeted MDRO.
- Nursing homes are strongly encouraged to use enhanced barrier precautions (EBPs) in addition to standard precautions when:
- Caring for residents with chronic wounds or indwelling medical devices regardless of their MDRO status.
- Caring for residents who are colonized or infected with a targeted MDRO when contact precautions do not otherwise apply.
-
Follow proper cleaning and disinfection processes. Health care and environmental services personnel should consult disinfectants' manufacturer’s instructions for use for any kill claims, contact times, and concentration specifications. Refer to the Environmental Protection Agency’s (EPA) List P for products that are effective against C. auris.
- Whenever possible, use single-use, disposable, non-critical equipment or dedicate equipment for patients or residents colonized or infected with a targeted MDRO. If this is not possible, disinfect shared medical equipment between patients or residents.
- Increase the frequency of cleaning, with additional focus on high-touch surfaces and the colonized or infected patient's or resident's room.
-
Practice proper hand hygiene. Health care personnel should perform hand hygiene throughout their shift. Patients or residents who are colonized or infected with an MDRO should be educated and encouraged to perform hand hygiene routinely.
-
Communicate patients’ or residents’ MDRO status and history. The CDC provides an Inter-Facility Information Control Transfer form to help assist in this communication. DHS highly recommends that health care providers flag a patient or resident’s electronic health record so that internal and external care providers can use proper precautions during health care encounters.
- A patient’s or resident’s MDRO status alone is not grounds to refuse their admission to a health care facility. For questions regarding patient or resident management and MDROs, please contact your regional infection preventionist.
-
Utilize colonization screening to rapidly identify targeted MDROs. Colonization screening refers to the process of testing or screening someone for the presence of a specific MDRO.
- A health care facility may conduct response-driven screening after identifying a patient or resident who is infected or colonized with a targeted MDRO to determine if other patients or residents in the facility are also colonized. See frequently asked questions on MDRO colonization screening in health care facilities (also available in Spanish) for additional information.
- A health care facility may choose to conduct admission screening of high-risk patient or resident populations to identify MDROs at the time of admission.
- The Wisconsin State Laboratory of Hygiene offers fee-exempt colonization testing supplies to Wisconsin health care facilities. For more details on colonization screening, please reach out to the Wisconsin Healthcare-Associated Infections (HAI) Prevention Program.
-
Implement an antimicrobial stewardship program. An effective antimicrobial stewardship program can help address the overarching problem of emerging antibiotic-resistant bacteria by reducing the overprescribing of antibiotics. Learn more about stewardship programs based on care setting at, Antimicrobial Stewardship: Resources for Health Care Providers.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist
Bureau of Communicable Diseases
Division of Public Health
Wisconsin Department of Health Services
DHS resources
Questions
Questions regarding this health alert may be directed to the HAI Prevention Program via email to DHSWIHAIPreventionProgram@dhs.wisconsin.gov.
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