Select health care–associated infections are declining

Abstract

Central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and Clostridioides difficile infections all declined between 2017 and 2018 across four health care settings, according to CDC’s National and State Healthcare-Associated Infections Progress Report, released in November 2019. Health care–associated infections can result in increased morbidity and mortality, length of hospital stay, and health care–associated costs. The report compiles data from more than 22,000 active hospitals and other health care facilities: acute care hospitals, critical access hospitals, inpatient rehabilitation facilities, and long-term acute care hospitals. The results suggest that interventions targeted at reducing these types of infections appear to be working, with antibiotic stewardship efforts a main factor in the declining rates. Overall, CLABSIs decreased 9% between 2017 and 2018, with the largest decrease in the ICU (11%). One intervention that has led to reduced CLABSI rates is bundle implementation with use of chlorhexidine dressings, said Amy Hanson, PharmD, BCPS AQ-ID, an antimicrobial stewardship and infectious disease pharmacist at the Chicago Department of Public Health, in an interview with Pharmacy Today. “In a study conducted during my time at Rush [University Medical Center in Chicago], we published data showing that moving from peripheral draw to phlebotomist draw via central lines had a reduction in CLABSI rates over time, by reducing the contamination risk (false-positive CLABSIs),” said Hanson. “This was particularly true in certain patient populations, such as our hematology/oncology patients. We were also able to show a reduction in vancomycin use over time.” For CAUTIs, there was about an 8% decrease between 2017 and 2018, with the largest decrease also observed in the ICU for this infection (10%). Hanson noted that a number of basic interventions could have contributed to the reduction in CAUTI rates, such as the many interventions focused primarily on education and training. Others include local adoption of guidelines or protocols, use of an opinion leader, audit and feedback, multidisciplinary team involvement, and reminders and stop orders. Hospital-onset C. difficile infections saw about a 12% decrease between 2017 and 2018. Antibiotic stewardship intervention efforts aimed at lowering C. difficile rates, such as those recommended in the C. difficile guidelines of the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America, have surely contributed to this decline, noted Hanson. These include implementation of restrictions on the use of certain antibiotics (primarily fluoroquinolones) and the potentially broader use of prophylactic oral vancomycin in high-risk patients receiving broad-spectrum systemic antibiotics. Another CDC report, Antibiotic Resistance Threats in the U.S. 2019, revealed improvements in select areas, with 18% fewer deaths from antibiotic resistance and 28% fewer deaths from antibiotic resistance in hospitals. When individual pathogens were assessed, infections caused by vancomycin-resistant Enterococcus decreased by 41%, multidrug-resistant Pseudomonas aeruginosa by 29%, methicillin-resistant Staphylococcus aureus (MRSA) by 21%, carbapenem-resistant Acinetobacter baumannii by 33%, and drug-resistant Candida species by 25%. Rates of carbapenem-resistant Enterobacteriaceae and drug-resistant tuberculosis disease cases remained stable. CDC attributed some of these findings to interventions that focus on preventing device- and procedure-related infections, such as urinary catheters or central lines; stopping the spread of resistant germs within and between health care facilities; containing emerging threats through early detection and aggressive response; tracking and improving appropriate antibiotic use; and infection prevention and control in nonhospital settings, such as long-term-care facilities. Although rates of CLABIs, CAUTIs, and C. difficile appear to be declining, other infections saw no change in their rates between 2017 and 2018, including ventilator-associated pneumonia, skin and soft tissue infections, and hospital-onset MRSA bacteremia. In addition, in CDC’s report on antibiotic resistance, the agency reported that more than 2.8 million antibiotic-resistant infections—and more than 35,000 deaths from antibiotic resistance—occur each year. These data suggest that more work needs to be done to help reduce the rates of these infections. Pharmacists working in acute and long-term health care settings can play an active role in helping implement interventions aimed at improving the rates of these infections, with a focus on antibiotic stewardship efforts.