This article is more than 5 years old. Information may no longer be current.
HAIs decreasing; antibiotic resistant bacteria still threaten inpatients
Click Here to Manage Email Alerts
Despite continuing reductions in the overall incidence of health care-associated infections, or HAIs, antibiotic resistant bacteria continue to be responsible for a substantial portion of these nosocomial infections, according to data recently published in MMWR.
The findings, which build upon previously reported HAI incidence surveys, suggest one in seven catheter- and surgery-related HAIs occurring in acute care hospitals during 2014 were caused by non-Clostridium difficile antibiotic resistant bacteria. In long-term facilities, this same incidence was increased to one in four, a rate that CDC Director Thomas R. Frieden, MD, MPH, said represents an area of health care in vital need of improvement.
Thomas R. Frieden
“Antibiotic resistance threatens to return us to a time when a simple infection could kill,” Frieden said during a press conference. “The more people who get infected with resistant bacteria, the more who suffer complications [and] who, tragically, may die from preventable infections.”
These data were culled from 2014 National Healthcare Safety Network reports collected from hospitals throughout the United States. CDC researchers determined the incidence of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs) and laboratory-confirmed C. difficile infections collectively and by care settings. Antibiotic susceptibility of the pathogens responsible for each event were provided by the facility’s clinical microbiology laboratory, and standardized infection ratios (SIRs) were calculated for each HAI using previously established baselines.
Approximately 4,000 acute care hospitals, 501 long-term acute care hospitals and 1,135 inpatient rehabilitation facilities contributed data to NHSN. From 2013 to 2014, acute care hospitals reported an 8% decrease in CLABSIs and 5% in CAUTIs, but 4% increases in C. difficile infections and 2% gains in SSI. Long term care facilities reported a 9% CLABSI decrease and an 11% CAUTI decrease, while rehabilitation facilities saw a 14% reduction in CAUTIs. Among all settings, CLABSIs were shown to have decreased approximately 50% since the 2008 baseline while SSIs related to 10 procedures fell 17%; however, no change in overall CAUTIs was seen since the 2009 baseline.
Nearly half of all health-care associated Staphylococcus aureus infections were methicillin-resistant, while 29.5% of enterococci were resistant to vancomycin and 52.6% of Acinetobacter species were multidrug-resistant. Disregarding C. difficile, antibiotic resistant bacteria were responsible for 14% of all HAIs in short-term acute care hospitals, 12% of HAIs in inpatient rehabilitation facilities and 29% of long-term acute care facilities. These resistant bacteria were most prevalent among CLABSIs regardless of setting.
“There is encouraging news here,” Frieden said. “Doctors, nurses, hospitals, health care systems and other partners have made progress preventing some HAIs, but today’s [report] shows that the resistant bacteria that we’re most concerned about … are still playing a significant role in CLABSIs, SSIs and CAUTIs.”
During the press event, Frieden outlined CDC’s recommendations for health care workers to reduce the impact of these infections, which included catheter or surgical precautions and the implementation of antibiotic stewardship programs. Other recommendations provided by Peter Pronovost, MD, PhD, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins, included proper hand hygiene, equipment sterilization, frequent catheter monitoring and antibiotic “time-outs.”
“As we treat these infections, we can sometimes inadvertently place our patients in the middle of yet another crisis,” Pronovost said during the press conference. “No hospital is immune from this problem, and we all have work to do.”
While doctors and health care workers may be on the front lines of this issue, Frieden said that equal effort is needed from other contributors to the health care system.
“Health care professionals need the support of their facility leadership — they can’t accomplish this task alone,” Frieden said. “Health care facilities, CEOs [and] administrators are a major part of the solution. It’s important that they make a priority of infection prevention, sepsis prevention and antibiotic stewardship.”
The message to health care administrations was echoed by the Society for Healthcare Epidemiology of America (SHEA). In a responding statement, the society urged facilities and staff to designate appropriate effort and funding toward infection prevention programs, which it said can reduce antibiotic resistant bacteria mortality.
Louise-Marie Dembry
“We know how to prevent many HAIs,” Louise-Marie Dembry, MD, MBA, president of SHEA, said in the statement. “Health care facilities and health care 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.” – by Dave Muoio
Disclosure: The researchers report no relevant financial disclosures. Frieden and Dembry report no relevant financial disclosures. Infectious Disease News was unable to determine Pronovost’s relevant financial disclosures at the time of publication.
Click Here to Manage Email Alerts