CDC Vital Signs: Preventing Antibiotic-Resistant Infections in Health Care Settings
Morbidity and Mortality Weekly Report (MMWR)
Early Release
March 3, 2016 / 65
Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014
Abstract
Background: Health care–associated antibiotic-resistant (AR) infections increase patient morbidity and mortality and might be impossible to successfully treat with any antibiotic. CDC assessed health care–associated infections (HAI), including Clostridium difficile infections (CDI), and the role of six AR bacteria of highest concern nationwide in several types of health care facilities.
Methods: During 2014, approximately 4,000 short-term acute care hospitals, 501 long-term acute care hospitals, and 1,135 inpatient rehabilitation facilities in all 50 states reported data on specific infections to the National Healthcare Safety Network. National standardized infection ratios and their percentage reduction from a baseline year for each HAI type, by facility type, were calculated. The proportions of AR pathogens and HAIs caused by any of six resistant bacteria highlighted by CDC in 2013 as urgent or serious threats were determined.
Results: In 2014, the reductions in incidence in short-term acute care hospitals and long-term acute care hospitals were 50% and 9%, respectively, for central line-associated bloodstream infection; 0% (short-term acute care hospitals), 11% (long-term acute care hospitals), and 14% (inpatient rehabilitation facilities) for catheter-associated urinary tract infection; 17% (short-term acute care hospitals) for surgical site infection, and 8% (short-term acute care hospitals) for CDI. Combining HAIs other than CDI across all settings, 47.9% of Staphylococcus aureus isolates were methicillin resistant, 29.5% of enterococci were vancomycin-resistant, 17.8% of Enterobacteriaceae were extended-spectrum beta-lactamase phenotype, 3.6% of Enterobacteriaceae were carbapenem resistant, 15.9% of Pseudomonas aeruginosa isolates were multidrug resistant, and 52.6% of Acinetobacter species were multidrug resistant. The likelihood of HAIs caused by any of the six resistant bacteria ranged from 12% in inpatient rehabilitation facilities to 29% in long-term acute care hospitals.
Conclusions: Although there has been considerable progress in preventing some HAIs, many remaining infections could be prevented with implementation of existing recommended practices. Depending upon the setting, more than one in four of HAIs excluding CDI are caused by AR bacteria.
Implications for Public Health Practice: Physicians, nurses, and health care leaders need to consistently and comprehensively follow all recommendations to prevent catheter- and procedure-related infections and reduce the impact of AR bacteria through antimicrobial stewardship and measures to prevent spread.
Key points
• Antibiotic-resistant (AR) bacteria can make infections impossible to treat, especially given the extensive resistance frequently encountered in health care facilities. Of 18 AR bacteria identified by CDC as public health threats, six, in addition to Clostridium difficile, cause health care–associated infections (HAIs).
• Three common HAIs associated with catheters placed in a vein or the bladder and procedures (operations) include: central-line associated blood stream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and surgical site infections (SSIs).
• Preventing these HAIs is an important strategy for reducing the impact of AR bacteria on human health, including the prevention of sepsis and death. Considerable progress has been made for some but not all HAIs. Compared with baseline historic data from 5–8 years earlier, CLABSIs decreased by 50% and SSIs by 17% in 2014. Whereas CAUTIs appear unchanged from baseline, there have been recent decreases. C. difficile infections in hospitals decreased 8% during 2011–2014.
• In 2014, the chance that an HAI was caused by one of the six AR threat bacteria was one in seven in short-term acute care hospitals but higher in other health care settings such as long-term acute care hospitals where it was one in four.
• Physicians, nurses, and health care leaders, working together with the help of CDC, other federal agencies, and other partners, need to consistently combine strategies to prevent catheter- and procedure-related HAIs, prevent the spread of AR bacteria, and improve antibiotic use, thereby preventing further patient harm caused by AR HAIs.
• Additional information available at http://www.cdc.gov/vitalsigns.
Centers for Disease Control and Prevention
www.cdc.gov
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