COMMENTARY

What Healthcare-Associated Infections Are Resistant in Your State?

Scott Fridkin, MD

Disclosures

July 05, 2016

Editorial Collaboration

Medscape &

Antibiotic Resistance Patterns

The Centers for Disease Control and Prevention (CDC) recently called for healthcare providers and healthcare facility leaders to know the antibiotic resistance patterns in their area as a way to protect patients, stop the spread of infections, and slow the development of antibiotic resistance.[1] Antibiotic resistance sickens 2 million people and kills at least 23,000 people in the United States each year.[2] In some hospitals, 1 in 4 healthcare-associated infections (HAIs) is caused by antibiotic-resistant bacteria identified by CDC as urgent or serious threats to health.[3]

Launched in March 2016, the Antibiotic Resistance Patient Safety Atlas takes data previously reported in lengthy spreadsheets and makes these data accessible in an interactive web app. The Atlas includes data on HAIs caused by antibiotic-resistant bacteria reported to CDC's National Healthcare Safety Network from more than 4000 US healthcare facilities from 2011 to 2014.[4]

Providers can see graphic representations of the percent resistance (%R) for any of 31 bug-drug combinations, including pathogens identified by CDC as urgent or serious threats, like methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and Pseudomonas aeruginosa. Users can also filter data by geographical area, time period, event type (catheter-associated urinary tract infection, central-line–associated bloodstream infection, or surgical-site infection), and patient age.

Dissecting the Data

The %R metric may be particularly valuable to infectious disease specialists and antibiotic stewardship leaders who can use the data as an indicator for what types of resistance may be most pressing and worthy of investigation in certain regions or states. The Atlas data show that improvements in stopping HAIs caused by resistant bacteria have been made, but more work remains to be done:

  • Resistant HAIs affect young and old patients and occur in all three of the common event types reported in the Atlas.

  • The percent of MRSA with characteristics suggesting that the strain originated in the community (community-associated MRSA) caused 31% of the HAIs in which MRSA was reported nationally, with a range of 10% to 55.5% among states.

  • The percent of MRSA and additional antibiotics commonly used to treat MRSA (linezolid, daptomycin, or intermediate/resistance to vancomycin) causing HAIs were rarely reported (0.7%, 1.3%, and 0.2%, respectively) across the country.

  • The percent of CRE causing HAIs among states ranged from 0% to 27.9% (3.5% nationally), with higher %R in several Northeast states and sporadically across the country.

  • The percent of E coli resistant to fluoroquinolones (a commonly prescribed class of antibiotics for infections thought to be caused by E coli and related organisms) causing HAIs among states ranged from 12.1% to 50.5% (33.0% national resistance).

  • The percent of P aeruginosa resistant to piperacillin/tazobactam causing HAIs ranged from 0% to 41.7% among states (10% national resistance).

Applying the Data to Practice

As physicians, nurses, and healthcare facility administrators, these data make it clear that we must continue to do our part to prevent HAIs by combining three critical efforts:

  • Prevent infections related to surgery and/or placement of a catheter. Follow recommendations for preventing Clostridium difficile and infections that can occur after surgery or are related to single-use catheters placed in the body. Follow recommended actions with every patient every time.

  • Prevent the spread of bacteria between patients and facilities with the coordinated approach: Administrators can communicate with public health departments to share data about antibiotic resistance and HAIs, and implement systems to alert receiving facilities when transferring patients who have drug-resistant organisms. Providers should isolate patients when appropriate, know antibiotic resistance patterns in their facility/area, and ask patients whether they have recently received care in another facility.

  • Improve antibiotic use through stewardship. Prescribe antibiotics correctly. Get cultures, start antibiotics promptly, and reassess 24-48 hours later. Know when to stop antibiotic treatment.

  • Use these data to prioritize antibiotic resistance activities as they relate to infection and sepsis prevention, and antibiotic stewardship. Participate in a Quality Innovation Network.

CDC encourages healthcare providers and administrators to explore their own state's data and share it with others as part of efforts to stop HAIs and combat the threat of antibiotic resistance in your healthcare facility and community.

Web Resources

AR Patient Safety Atlas

Preventing Healthcare-associated Infections

Improving Antibiotic Prescribing and Use

National and State Healthcare-Associated Infections Progress Report

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