Abstract
BackgroundTrends in antimicrobial resistance help inform infection control efforts. We examined trends in resistance for Enterobacteriaceae and Acinetobacter spp. from 2013 to 2017 in hospitalized US patients.MethodsWe analyzed antimicrobial susceptibility of non-duplicate isolates in hospitalized patients (not limited to hospital-acquired infections) in the US BD Insights Research Database. Resistance profiles of interest were extended-spectrum beta-lactamase (ESBL)-producing, multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes of Enterobacteriaceae, and MDR and Carb-NS Acinetobacter spp. Time series models were used to evaluate the patterns of resistance trends in rate per 100 hospital admissions and proportion per isolates tested.ResultsMore than 1 million Enterobacteriaceae isolates were obtained from 411 hospitals; 12.05% were ESBL, 1.21% Carb-NS, and 7.08% MDR. Urine was the most common source. For Acinetobacter spp. (n = 19,325), 37.48% were Carb-NS, 47.66% were MDR, and the most common source was skin/wound cultures. Trend analyses showed that the rates of ESBL and Carb-NS Enterobacteriaceae per 100 hospital admissions increased significantly between 2013 and 2017. Rates of MDR Enterobacteriaceae and Carb-NS and MDR Acinetobacter spp. decreased during this time period. Trends in proportions of resistant isolates generally mirrored trends in rates per 100 hospital admissions. MDR Enterobacteriaceae and Carb-NS and MDR Acinetobacter spp. were more common in winter than summer.ConclusionsIn this large-scale study of patients in US hospitals, rates of ESBL and Carb-NS Enterobacteriaceae per 100 hospital admissions increased between 2013 and 2017. MDR Enterobacteriaceae and MDR and Carb-NS Acinetobacter spp. isolates decreased over this period. These data support continuing infection control and stewardship efforts and the development of new therapeutic options.
Highlights
Trends in antimicrobial resistance help inform infection control efforts
Carbapenem-resistant and MDR Acinetobacter are featured on the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) lists of dangerous pathogens [1,2,3]
Our study evaluated antimicrobial susceptibility in five groups of Gram-negative bacteria using the following definitions as previously described [12, 13]: 1. extendedspectrum beta-lactamase (ESBL) Enterobacteriaceae: Escherichia coli, Klebsiella oxytoca, Klebsiella pneumoniae, and Proteus mirabilis isolates confirmed as ESBL positive by commercial laboratory panels OR with intermediate susceptibility or resistance to cefepime, ceftazidime, cefotaxime, or ceftriaxone
Summary
We examined trends in resistance for Enterobacteriaceae and Acinetobacter spp. from 2013 to 2017 in hospitalized US patients. Carbapenem-resistant Enterobacteriaceae (CRE) have limited treatment options and pose a significant clinical dilemma, but extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and multidrug-resistant (MDR) Enterobacteriaceae are difficult to treat and occur at a higher prevalence, endangering a greater number of patients [6]. The Centers for Disease Control and Prevention (CDC) categorizes CRE and ESBL-producing Enterobacteriaceae as urgent and serious threats, respectively, and the World Health Organization (WHO) considers them a critical priority for drug development [1,2,3]. Acinetobacter infections are relatively rare, Gupta et al BMC Infectious Diseases (2019) 19:742 this pathogen is difficult to treat due to high rates of antibiotic resistance and paucity of options [7]
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