'Chilling' Data on Antibiotic-Resistant Infections in US Hospital Patients

Megan Brooks

March 03, 2016

US hospitals and healthcare providers have made considerable progress in preventing some healthcare-associated infections (HAIs), but the battle is far from over, as antibiotic-resistant bacteria continue to threaten hospital patients, officials with the Centers for Disease Control and Prevention (CDC) said today.

"New data show that far too many patients are getting infected with dangerous, drug-resistant bacteria in healthcare settings," CDC Director Tom Frieden, MD, MPH, said in a news release.

Antibiotic-resistant infections can be "difficult or impossible to treat." Physicians, nurses, and healthcare leaders are "key to stamping out superbugs," Dr Frieden added during a media briefing. "No one should get sick while trying to get well." It is possible to reduce these infections, but it will take "relentless effort," he continued.

According to the CDC, each year, about 2 million Americans develop antibiotic-resistant infections, and roughly 23,000 die.

In a Vital Signs report published online March 3 in the Morbidity and Mortality Weekly Report, the CDC provides the latest data on HAIs, including Clostridium difficile infection (CDI) and the role of six antibiotic-resistant bacteria of "highest concern." They are:

  • carbapenem-resistant Enterobacteriaceae,

  • methicillin-resistant Staphylococcus aureus,

  • extended-spectrum β-lactamase-producing Enterobacteriaceae,

  • vancomycin-resistant Enterococcus,

  • multidrug-resistant Pseudomonas aeruginosa, and

  • multidrug-resistant Acinetobacter.

In 2014, the chance that an HAI was caused by one of these six antibiotic-resistant bacteria was one in seven in short-term acute care hospitals, a statistic Dr Frieden called "deeply concerning." In long-term acute care hospitals, the figure increases to a "chilling" one in four, he said.

'Hopeful and Humble' Data

However, there has also been considerable progress reducing some HAIs in recent years, which is "encouraging," Dr Frieden said.

Data in the Vital Signs report, coupled with data from the CDC's latest annual progress report on HAI prevention, show that short-term acute care hospitals achieved a 50% decrease in central line-associated bloodstream infections (CLABSIs) between 2008 and 2014. "This is important given the high morbidity, mortality, and excess costs associated with CLABSIs," the report notes. Long-term acute care facilities saw a 9% drop off in CLABSIs.

Short-term acute care hospitals also achieved a 17% decrease in surgical site infections between 2008 and 2014 related to 10 procedures.

However, between 2009 and 2014, there was no change in overall catheter-associated urinary tract infections in short-term acute care hospitals, but there was progress in "non-[intensive care unit] settings, progress in all settings between 2013 and 2014, and most notably, even more progress in all settings towards the end of 2014," the CDC notes in the release. Long-term acute care hospitals saw an 11% decline in catheter-associated urinary tract infections.

C difficile, the most common type of bacteria responsible for infections in hospitals, caused 453,000 infections in the United States in 2011 alone, and 29,000 patients died as a result, the CDC says. Cases of C difficile infection in short-term acute care hospitals decreased only 8% overall between 2011 and 2014 and, "more concerning," increased 4% during 2013 to 2014. Methicillin-resistant Staphylococcus aureus infections fell by 13% from 2011 to 2014.

With this report, "I think we are both hopeful and humble: hopeful at the progress we've made, and humble at the work ahead of us," said Peter Pronovost, MD, PhD, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins in Baltimore, Maryland, during the press briefing.

The CDC encourages the healthcare community to continue to focus on preventing HAIs by preventing the spread of bacteria between patients, preventing infections related to catheters and surgery, and improving antibiotic use through stewardship.

"For clinicians, prevention means isolating patients when necessary," Clifford McDonald, MD, associate director for science at the CDC's Division of Healthcare Quality Promotion, and author on the Vital Signs report, said in the release. "It also means being aware of antibiotic resistance patterns in your facilities, following recommendations for preventing infections that can occur after surgery or from central lines and catheters placed in the body, and prescribing antibiotics correctly."

"The good news is that we are preventing healthcare-acquired infections, which has saved thousands of lives," added Patrick Conway, MD, deputy administrator and chief medical officer at the Centers for Medicare & Medicaid Services. "The challenge ahead is how we help to prevent antibiotic resistance, as well as infections. We are using incentives, changes in care delivery, and transparency to improve safety and quality for patients."

In response to the Vital Signs report, Louise-Marie Dembry, MD, MBA, president of the Society for Healthcare Epidemiology of America, said in a statement, "We know how to prevent many HAIs. Healthcare facilities and healthcare systems need to invest in keeping patients safe by ensuring infection prevention best practices are implemented and followed and stewardship strategies are in place to help clinicians make informed decisions about the antibiotics they prescribe for their patients."

The CDC also announced today the release of the Antibiotic Resistance Patient Safety Atlas, a new web app with interactive data on national, regional, and state HAIs caused by antibiotic-resistant bacteria.

Congress has also recognized the urgent need to combat antibiotic resistance. In fiscal year 2016, Congress appropriated $160 million in new funding to the CDC to help the agency fight the spread of antibiotic resistance by accelerating outbreak detection and prevention in every state, enhancing tracking of resistance mechanisms and resistant infections, supporting research to address current gaps in knowledge, and improving antibiotic use.

Morb Mortal Wkly Rep. Published online March 3, 2016. Full text


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