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Resistance outbreaks common across all bacterial species in ICU
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Recent data suggest that outbreaks occur for most bacterial species that are common in the ICU, and there were outbreaks of resistance in at least one species group for most antibiotics.
“It is unclear to what extent outbreaks of resistance can be ascribed to horizontal gene transfer relative to other possible mechanisms of resistance spread,” the researchers wrote in Clinical Infectious Diseases. “Quantifying the relative importance of these mechanisms would help target infection control and antimicrobial stewardship strategies.”
Researchers from the United Kingdom conducted a retrospective analysis that included data on all patients admitted to two ICUs between 2002 and 2009. All bacteria present in patient specimens were identified and underwent antimicrobial susceptibility. The bacteria were classified into species-groups. The researchers then analyzed all species-groups with more than five unique patient isolates in one ICU and analyzed resistance outbreaks.
They identified 9,428 unique patient-species isolates that were included in the analysis and 26 species-groups. In ICU-1, outbreaks were detected for 15 of the 26 species-groups (58%), and in ICU-2, outbreaks were detected for nine of the 26 species-groups (35%). In ICU-1, there were 24 outbreaks of resistance detected, and in ICU-2, there were 15 outbreaks of resistance. Sixteen antibiotics were analyzed, and 10 (63%) had resistant outbreaks in one or more species-group.
“A better understanding of the relative contribution of the several mechanisms of resistance emergence and spread on ICU is needed to inform antimicrobial stewardship and infection control programs,” the researchers wrote. “Further studies using automated outbreak detection software, combined with targeted sequencing of bacterial genomes, will be required to determine the contribution of inter-species gene transfer to resistance emergence in the hospital setting.”
Disclosure: The study was funded by a grant from Pfizer.
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