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. 2015 Jan;36(1):54-64.
doi: 10.1017/ice.2014.11.

Evaluating state-specific antibiotic resistance measures derived from central line-associated bloodstream infections, national healthcare safety network, 2011

Minn M Soe  1 , Jonathan R Edwards  1 , Dawn M Sievert  1 , Philip M Ricks  1 , Shelley S Magill  1 , Scott K Fridkin  1
Affiliations

Evaluating state-specific antibiotic resistance measures derived from central line-associated bloodstream infections, national healthcare safety network, 2011

Minn M Soe et al. Infect Control Hosp Epidemiol. 2015 Jan.

Abstract

DISCLOSURE The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Diseases Registry. OBJECTIVE Describe the impact of standardizing state-specific summary measures of antibiotic resistance that inform regional interventions to reduce transmission of resistant pathogens in healthcare settings. DESIGN Analysis of public health surveillance data. METHODS Central line-associated bloodstream infection (CLABSI) data from intensive care units (ICUs) of facilities reporting to the National Healthcare Safety Network in 2011 were analyzed. For CLABSI due to methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin (ESC)-nonsusceptible Klebsiella species, and carbapenem-nonsusceptible Klebsiella species, we computed 3 state-level summary measures of nonsusceptibility: crude percent nonsusceptible, model-based adjusted percent nonsusceptible, and crude infection incidence rate. RESULTS Overall, 1,791 facilities reported CLABSIs from ICU patients. Of 1,618 S. aureus CLABSIs with methicillin-susceptibility test results, 791 (48.9%) were due to MRSA. Of 756 Klebsiella CLABSIs with ESC-susceptibility test results, 209 (27.7%) were due to ESC-nonsusceptible Klebsiella, and among 661 Klebsiella CLABSI with carbapenem susceptibility test results, 70 (10.6%) were due to carbapenem-nonsusceptible Klebsiella. All 3 state-specific measures demonstrated variability in magnitude by state. Adjusted measures, with few exceptions, were not appreciably different from crude values for any phenotypes. When linking values of crude and adjusted percent nonsusceptible by state, a state's absolute rank shifted slightly for MRSA in 5 instances and only once each for ESC-nonsusceptible and carbapenem-nonsusceptible Klebsiella species. Infection incidence measures correlated strongly with both percent nonsusceptibility measures. CONCLUSIONS Crude state-level summary measures, based on existing NHSN CLABSI data, may suffice to assess geographic variability in antibiotic resistance. As additional variables related to antibiotic resistance become available, risk-adjusted summary measures are preferable.

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Conflict of interest statement

Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.

Figures

FIGURE 1
FIGURE 1
State-specific rate and percentage of isolates with resistant phenotypes, reported as central line-associated bloodstream infections (CLEBSIs) from intensive care units, National Healthcare Safety Network, 2011. Triangle represents point estimate of rate per 1,000 device days, open bar represents crude proportion and grey bar represents adjusted proportion. Graph 1A represents methicillin-resistant Staphylococcus aureus (MRSA). Graph 1B represents extended-spectrum cephalosporin-nonsusceptible (ESC-NS) Klebsiella spp. Graph 1C represents carbapenem-nonsusceptible (C-NS) Klebsiella spp.
FIGURE 2
FIGURE 2
Distributions of state-specific percentage of pathogenic central line-associated bloodstream infection (CLEBSI) isolates nonsusceptible to selected antibiotics in intensive care units, unadjusted (crude) vs. adjusted (model-based) values, National Healthcare Safety Network, 2011. MRSA, methicillin resistant S. aureus; ESC-NS, extended-spectrum cephalosporin-nonsusceptible Klebsiella spp.; C-NS, carbapenem-nonsusceptible Klebsiella spp. Horizontal lines represent maximum, minimum, 75th, 50th, and 25th percentile values. Diamond represents the mean value.
FIGURE 3
FIGURE 3
Linked values of unadjusted (crude) and adjusted (model-based) state-specific percentage of isolates with selected resistance phenotype among central line-associated bloodstream infections (CLEBSIs) from intensive care units, by state, National Healthcare Safety Network, 2011. Graph 3A represents methicillin-resistant Staphylococcus aureus (MRSA). Graph 3B represents extended-spectrum cephalosporin-nonsusceptible (ESC-NS) Klebsiella spp. Graph 3C represents carbapenem-nonsusceptible (C-NS) Klebsiella spp.
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References

    1. U.S. Department of health and Human Services & Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. Centers for Disease Control and Prevention; [Accessed February 3, 2014]. website http://www.cdc.gov/drugresistance/threat-report-2013/index.html. Published 2013.
    1. Cosgrove SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis. 2006;42(Suppl 2):S82–S89. - PubMed
    1. Maragakis LL, Perencevich EN, Cosgrove SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther. 2008;6:751–763. - PubMed
    1. Shorr AF. Review of studies of the impact on Gram-negative bacterial resistance on outcomes in the intensive care unit. Crit Care Med. 2009;37:1463–1469. - PubMed
    1. European Centre for Disease Prevention and Control. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net) Stockholm: European Centre for Disease Control and Prvention; 2012. Antimicrobial resistance surveillance in Europe 2011.

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