NEWS & NOTES

Conference Summary pneumoniae can vary among popula- conference sessions was that statically tions and is influenced by local pre- sound methods of data collection that Drug-resistant scribing practices and the prevalence capture valid, meaningful, and useful of resistant clones. Conference pre- data and meet the financial restric- Streptococcus senters discussed the role of surveil- tions of state budgets are indicated. pneumoniae and lance in raising awareness of the Active, population-based surveil- Methicillin- resistance problem and in monitoring lance for collecting relevant isolates is the effectiveness of prevention and considered the standard criterion. resistant control programs. National- and state- Unfortunately, this type of surveil- Staphylococcus level epidemiologists discussed the lance is labor-intensive and costly, aureus benefits of including state-level sur- making it an impractical choice for 1 veillance data with appropriate antibi- many states. The challenges of isolate Surveillance otic use programs designed to address collection, packaging and transport, The Centers for Disease Control the antibiotic prescribing practices of data collection, and analysis may and Prevention (CDC) convened a clinicians. The potential for local sur- place an unacceptable workload on conference on March 12–13, 2003, in veillance to provide information on laboratory and epidemiology person- Atlanta, Georgia, to discuss improv- the impact of a new pneumococcal nel. ing state-based surveillance of drug- vaccine for children was also exam- Epidemiologists from several state resistant Streptococcus pneumoniae ined; the vaccine has been shown to health departments that have elected (DRSP) and methicillin-resistant reduce infections caused by resistance to implement enhanced antimicrobial Staphylococcus aureus (MRSA). The strains drug-resistance surveillance programs Council of State and Territorial Since the early 1990s, S. aureus presented alternative surveillance Epidemiologists, the Association of infections resistant to oxacillin methods currently implemented in Public Health Laboratories, and CDC (MRSA) have increased steadily. their states. Several surveillance mod- co-sponsored the conference; 120 par- Several scientists reported two recent els and knowledge gained by state- ticipants from 38 states attended. The changes in the epidemiology of based epidemiologists provided key conference was organized by the MRSA: its emergence in persons insights into the challenges and bene- Divisions of Healthcare Quality without established risk factors and fits of implementing enhanced sur- Promotion and Bacterial and Mycotic the emergence of vancomycin-resist- veillance programs. Diseases, National Center for ant S. aureus (VRSA). These new Two methods frequently used by Infectious Diseases, CDC. Goals of developments underscore the need for states are sentinel (i.e., survey of sub- the meeting included 1) reviewing the scientifically valid, yet financially set of laboratories) and antibiogram rationale for surveillance of DRSP feasible, state-based surveillance that (i.e., cumulative susceptibility data) and MRSA, 2) presenting scientific will aid in understanding the changing surveillance. Common difficulties studies highlighting valid and mean- epidemiology of MRSA disease. Such were identified with implementing ingful methods of performing state- understanding will allow effective sentinel systems. Those difficulties level surveillance, 3) sharing state- implementation of MRSA prevention included logistical obstacles with iso- level surveillance experiences, and 4) and control programs. Prevention pro- late or data processing and communi- identifying unmet needs of the state grams will differ on the basis of which cation breakdowns between laborato- health departments in performing populations are most affected (long- ry, epidemiology, and hospital infec- such surveillance. term care, community, and hospice). The primary theme of the confer- Current programs focus on reducing 1Presenters included the following: Richard ence general sessions was the public cross-transmission through improved E. Besser, Centers for Disease Control health impact of DRSP and MRSA hand hygiene and wound care. (More and Prevention (CDC); Clare Kioski, and the need for accurate surveillance information is available from: URL: Arizona Department of Health Services; Cynthia G. Whitney, CDC; Scott K. Fridkin, data to track and monitor resistance http://www.cdc.gov/ncidod/hip/Aresi CDC; Kathleen LeDell, Minnesota trends. S. pneumoniae is a major st/aresist.htm). Department of Health; Elizabeth Bancroft, cause of respiratory infections in the Conference participants generally Los Angeles County Department of Health United States. Since the early 1990s, agreed that a lack of resources for sur- Services; Scott Seys, Wyoming State the prevalence of resistance to single veillance has challenged state public Health Department; Felicia Medella, Nebraska Health and Human Services; and multiple antibiotics has been health agencies committed to moni- Chris A. Van Beneden, CDC; and Norman increasing in pneumococci. toring emerging antimicrobial drug Crouch, Public Health Laboratory, Antimicrobial drug resistance in S. resistance. A conclusion drawn from Minneapolis, Minnesota.

1358 Emerging Infectious Diseases • Vol. 9, No. 10, October 2003 NEWS & NOTES tion control personnel. Care must be data from these systems are substan- methods will assist local health taken in selecting the numbers and tial and will assist prevention pro- authorities in making decisions pro- types of laboratories to participate in grams. grams to monitor antimicrobial drug the sentinel network States collecting Another aspect of surveillance resistance. The 2-day conference pro- antibiograms from hospitals and state focuses on detecting rare events. Such vided an opportunity to initiate an laboratories also face challenges, reports may include new changes in exchange of current practices and including incompatible formatting of susceptibility, new mechanisms of knowledge gained among states and drug-testing panels, the inconsistent resistance, susceptibility of unusual territories. This process marks the inclusion of duplicate or repeat iso- pathogens, and unexpected sources of first phase in building networks that lates, and inconsistent reporting of resistant organisms. Establishing may potentially enhance training denominator data. Solutions to these good communication among person- resources, provide guidance for pro- problems commonly involve improv- nel in health departments and clinical gram development, and identify fur- ing communication between clinical laboratories is important for improv- ther technical assistance needed from microbiology laboratories and state ing reporting of such events. CDC. health departments, including labora- Allocating resources for improved tory input in decision making and pro- surveillance is considered a practical Leigh Ann Hawley,* viding feedback of data from the sys- and responsive step for states interest- Scott K. Fridkin,* tem to participants. Guidance for ed in tracking local resistant trends. and Cynthia G. Whitney* aggregating cumulative susceptibility Local data are important for raising *Centers for Disease Control and data (i.e., antibiograms) has been pub- public awareness, establishing Prevention, Atlanta, Georgia, USA lished and can serve as a guide for resources and prevention activities, Address for correspondence: Leigh Ann states and clinical microbiology labo- developing and informing treatment Hawley, Division of Bacterial and Mycotic ratories in conducting surveillance. guidelines, monitoring trends, and Diseases, National Center for Infectious Also, having designated staff was motivating behavior change among Diseases, Centers for Disease Control and essential for successfully implement- clinicians. Prevention, 1600 Clifton Road, Mailstop C23, ing most programs. Presenters agreed This meeting and ongoing efforts Atlanta, GA 30333, USA: fax: 404-639-3970; that the benefits of collecting local to study and validate surveillance email: [email protected]

Full text free online at www.cdc.gov/eid

The print journal is available at no charge to public health professionals

YES, I would like to receive Emerging Infectious Diseases.

Please print your name and business address in the box and return by fax to 404-371-5449 or mail to EID Editor CDC/NCID/MS D61 1600 Clifton Road, NE Atlanta, GA 30333

Moving? Please give us your new address (in the box) and print the number of your old mailing label here______

Emerging Infectious Diseases • Vol. 9, No. 10, October 2003 1359