Surveillance and Screening of AROs (Antimicrobial Resistant Organisms)
08:00 – 08:15
- Opening Remarks
Dr. John Conly and Dr. James Talbot
08:15 – 09:45
QUESTION 1: Overview
a) What are AROs? What is their incidence and prevalence (in health care facilities and in the community)? (Global, US, Canadian, and Alberta perspectives) Why are they a problem, globally and in Canada - what burden do they impose on patients and the health system?
- Incidence and Prevalence of AROs in Health Facilities and in the Community
Pilar Ramon-Pardo, MD, PhD
- What are Antimicrobial Resistant Organisms (AROs)? - Canadian Perspectives
Howard Njoo, MD, MHSc
b) Where do AROs come from (genetics and evolution)? How big a factor is the use of antimicrobials, and what is the contribution from various settings (healthcare, home, agriculture)?
- Can anything be done to prevent antibiotic resistance development?
Julian Davies, BSc, PhD, FRS
- Antimicrobial Drug Use in Animals as a Driver of Resistance
Scott McEwen, DVM, DVSc, Dip ACVP
- Questions and Answers 1
Dr. Pilar Ramon-Pardo, Dr. Howard Njoo, Dr. Julian Davies, and Dr. Scott McEwen
10:00 – 11:15
c) What is surveillance; what is screening? How are they related?
- What is Surveillance? What is Screening? How are They Related?
Joel Kettner, MD, MSc, FRCSC, FRCPC
d) What can we learn from the experience of other jurisdictions? (International, US, Canadian, and Alberta perspectives) Why does control of AROs vary so much? - e.g., is mandatory public reporting of data on AROs helpful?
- Surveillance for Antibiotic Resistant Organisms in Canadian Hospitals
Andrew Simor, MD, FRCPC
- What Can We Learn from Other Jurisdictions?
Robert Weinstein, MD
- Questions and Answers 1 (continued)
Dr. Joel Kettner, Dr. Andrew Simor, and Dr. Robert Weinstein
12:15 – 13:00
QUESTION 2: Surveillance
a) Why should we conduct surveillance? What do we do based on the results? What outcomes do we want, and are we achieving them?
- Definition and Uses of Surveillance
James Talbot, PhD, MD, FRCPC
b) How should we conduct surveillance – what options are available? What are the key areas of focus for surveillance in public health?
- How do we decide where to focus surveillance?
David Patrick, MD, FRCPC, MHSc
- Questions and Answers 2
Dr. James Talbot and Dr. David Patrick
13:00 – 14:40
QUESTION 3: Screening
a) Should we screen for AROs? Pro versus Con. Should we rely on horizontal measures only, i.e., general prevention? Should we rely on vertical measures, i.e., screen for multiple specific organisms? If we screen, what options should we use? – e.g., community vs admission; acute care vs. continuing care; patient selection; methods. If we screen, what should we do with the results, and how should we evaluate a screening program?
- Should We Screen for AROs? No!
Michael Edmond, MD, MPH, MPA
- controlling MRSA and multiple drug resistant organisms: experience in the Netherlands
Henri Verbrugh, MD, PhD, FIDSA
- To Screen or Not to Screen
Allison McGeer, MD, FRCPC
- Questions and Answers 3
Dr. Michael Edmond, Dr. Henri Verbrugh, and Dr. Allison McGeer
15:00 – 16:00
b) Is there a role for decolonization, and if so, when, and how?
- Is There a Role for Decolonization?
Susan Huang, MD, MPH
c) Why do screening practices vary so much between jurisdictions?
- Why Do Antimicrobial-Resistant Organism Screening Practices Vary Across Jurisdictions?
John Jernigan, MD, MS
- Questions and Answers 3 (continued)
Dr. Susan Huang and Dr. John Jernigan
08:30 – 10:30
QUESTION 4: What factors can facilitate or hinder effective ARO control in practice?
a) Organizational and cultural factors (barriers and enablers)
- Barriers and Facilitators to ARO Control
Elizabeth Bryce, BSc, MD, FRCPC
b) Lab capacity – what is the burden of ARO testing on labs; is it appropriate/cost-effective relative to other demands on lab resources? Are there changes or new options available that could reduce the burden?
- ARO Screening - Lab Issues
Daniel Gregson, MD, FRCPC
- Questions and Answers 4
Dr. Elizabeth Bryce and Dr. Daniel Gregson
10:00 – 12:00
QUESTION 5: Ethical and policy implications
a) What is appropriate screening for AROs in various settings?
- What is appropriate screening for ARO's in various settings?
Lindsay Nicolle, BSc, BSc (med), MD, FRCPC
b) What are the impacts of screening on patients, and on their family members and others? – eg, can screening do harm? Does it result in patients receiving reduced care due to “leperization” (stigma) and isolation? Does it impact eligibility/placement in home care and continuing care? Do patients have the right to refuse screening (or should they)?
- Contact precautions: Friend or foe?
Anthony Harris, MD, MPH
c) What is the economic cost/benefit of screening from the point of view of the individual patient; health care providers; and the funder of the health care system? How do we evaluate/measure the economic value of screening?
- What is the economic cost/benefit of screening?
Barry Cookson, BDS, MBBS, MSc, HonDipHIC, FRSPH, FRCP, FFPH, FRCPath
d) What can patients, the public, and health care providers do to help? Would more education re: appropriate use of antibiotics help reduce the incidence of AROs, and what would be the most effective strategy? What is the appropriate role of health care providers in ensuring responsible stewardship of antimicrobials?
- The Patient's Voice
- Patient Involvement
Yves Longtin, MD, FRCPC
- Questions and Answers 5
Dr. Lindsay Nicolle, Dr. Anthony Harris, Dr. Barry Cookson, Mrs. Kim Neudorf, and Dr. Yves Longtin
13:00 – 14:40
- Ongoing Gaps in Scientific Research to Facilitate ARO Policy in Healthcare
Trish Perl, MD, MSc
b) Outlining a Framework for ARO Screening/Surveillance Studies
- Outlining a Framework for Antimicrobial-Resistance Surveillance Studies
Eli Perencevich, MD, MS
c) Designing Interventional Studies for Evaluation of ARO Control Strategies
- Designing Interventional Studies for Evaluation of ARO Control Strategies
Mark Loeb, BSc, MSc, MD, FRCPC
d) How CIHR is Addressing Antimicrobial Resistance, Nationally, and Internationally
- How CIHR is Addressing Antimicrobial Resistance, Nationally and Internationally?
Serge Desnoyers, PhD
- Questions and Answers 6
Dr. Trish Perl, Dr. Eli Perencevich, Dr. Mark Loeb, and Dr. Serge Desnoyers
- Questions and Answers - Open Discussion
9:00 – 12:00
Reading of the Consensus Statement, open discussion, and comments on the statement
- Reading of the DRAFT Consensus Statement by Jury Chair
Tom Marrie, MD
Please note that the reading of the Consensus Statement by Dr. Tom Marrie is a working draft; the final draft is available below.
SURVEILLANCE and SCREENING of AROs (Antimicrobial-Resistant Organisms) - Consensus Statement of the Jury