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. 2018 May 17;66(11):1651-1657.
doi: 10.1093/cid/cix1076.

Antibiotic Resistance and the Risk of Recurrent Bacteremia

Sjoukje H S Woudt  1 , Sabine C de Greeff  1 , Annelot F Schoffelen  1 , Anne L M Vlek  1   2 , Marc J M Bonten  1   3   4 ; Infectious Diseases Surveillance Information System–Antimicrobial Resistance (ISIS-AR) Study Group
Collaborators, Affiliations

Antibiotic Resistance and the Risk of Recurrent Bacteremia

Sjoukje H S Woudt et al. Clin Infect Dis. .

Abstract

Background: Direct health effects of antibiotic resistance are difficult to assess. We quantified the risk of recurrent bacteremia associated with resistance.

Methods: We extracted antimicrobial susceptibility testing data on blood isolates from the Dutch surveillance system for antimicrobial resistance between 2008 and 2017. First and first recurrent (4-30 days) bacteremia episodes were categorized as susceptible, single nonsusceptible, or co-nonsusceptible to third-generation cephalosporins without or with carbapenems (Enterobacteriaceae), ceftazidime without or with carbapenems (Pseudomonas species), aminopenicillins without or with vancomycin (Enterococcus species), or as methicillin-sensitive/-resistant S. aureus (MSSA/MRSA). We calculated risks of recurrent bacteremia after nonsusceptible vs susceptible first bacteremia, estimated the crude population attributable effect of resistance for the Netherlands, and calculated risks of nonsusceptible recurrent bacteremia after a susceptible first episode.

Results: Risk ratios for recurrent bacteremia after a single- and co-nonsusceptible first episode, respectively, vs susceptible first episode, were 1.7 (95% confidence interval [CI], 1.5-2.0) and 5.2 (95% CI, 2.1-12.4) for Enterobacteriaceae, 1.3 (95% CI, 0.5-3.1) and 5.0 (95% CI, 2.9-8.5) for Pseudomonas species, 1.4 (95% CI, 1.2-1.7) and 1.6 (95% CI, 0.6-4.2) for Enterococcus species, and 1.6 (95% CI, 1.1-2.4) for MRSA vs MSSA. The estimated population annual number of recurrent bacteremias associated with nonsusceptibility was 40. The risk of nonsusceptible recurrent bacteremia after a susceptible first episode was at most 0.4% (Pseudomonas species).

Conclusions: Although antibiotic nonsusceptibility was consistently associated with higher risks of recurrent bacteremia, the estimated annual number of additional recurrent episodes in the Netherlands (40) was rather limited.

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Figures

Figure 1.
Figure 1.
Absolute number of first and recurrent bacteremia episodes between 1 January 2008 and 17 May 2017, by pathogen group and susceptibility category. A, Susceptible: susceptible to third-generation cephalosporins and carbapenems. Single nonsusceptible: (intermediate) resistant to third-generation cephalosporins, susceptible to carbapenems. Co-nonsusceptible: (intermediate) resistant to third-generation cephalosporins and carbapenems. B, Susceptible: susceptible to ceftazidime and carbapenems. Single nonsusceptible: (intermediate) resistant to ceftazidime, susceptible to carbapenems. Co-nonsusceptible: (intermediate) resistant to ceftazidime and carbapenems. C, Susceptible: susceptible to aminopenicillins and vancomycin. Single nonsusceptible: (intermediate) resistant to aminopenicillins, susceptible to vancomycin. Co-nonsusceptible: (intermediate) resistant to aminopenicillins and vancomycin. D, Susceptible: methicillin-sensitive Staphylococcus aureus. Single nonsusceptible: methicillin-resistant Staphylococcus aureus.
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