Abstract
BackgroundApproaches to controlling emerging antibiotic resistance in health care settings have evolved over time. When resistance to broad-spectrum antimicrobials mediated by extended-spectrum β-lactamases (ESBLs) arose in the 1980s, targeted interventions to slow spread were not widely promoted. However, when Enterobacteriaceae with carbapenemases that confer resistance to carbapenem antibiotics emerged, directed control efforts were recommended. These distinct approaches could have resulted in differences in spread of these two pathogens. CDC evaluated these possible changes along with initial findings of an enhanced antibiotic resistance detection and control strategy that builds on interventions developed to control carbapenem resistance.MethodsInfection data from the National Healthcare Safety Network from 2006–2015 were analyzed to calculate changes in the annual proportion of selected pathogens that were nonsusceptible to extended-spectrum cephalosporins (ESBL phenotype) or resistant to carbapenems (carbapenem-resistant Enterobacteriaceae [CRE]). Testing results for CRE and carbapenem-resistant Pseudomonas aeruginosa (CRPA) are also reported.ResultsThe percentage of ESBL phenotype Enterobacteriaceae decreased by 2% per year (risk ratio [RR] = 0.98, p<0.001); by comparison, the CRE percentage decreased by 15% per year (RR = 0.85, p<0.01). From January to September 2017, carbapenemase testing was performed for 4,442 CRE and 1,334 CRPA isolates; 32% and 1.9%, respectively, were carbapenemase producers. In response, 1,489 screening tests were performed to identify asymptomatic carriers; 171 (11%) were positive.ConclusionsThe proportion of Enterobacteriaceae infections that were CRE remained lower and decreased more over time than the proportion that were ESBL phenotype. This difference might be explained by the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains. Increased detection and aggressive early response to emerging antibiotic resistance threats have the potential to slow further spread.
Highlights
The emergence and spread of antibiotic resistance threatens to outpace the development of new antimicrobials, and slowing the spread of these organisms has become a priority
Among short-stay acute care hospitals, the percentage of Klebsiella and E. coli isolates with the ESBL phenotype remained relatively stable, ranging from 17.6% (116 of 659 isolates) in 2006 to 16.5% (694 of 4,211) in 2015, with a peak of 18.9% in 2009 (Figure 1)
During 2006–2015, the annual percentage of isolates with the ESBL phenotype declined an average of 2% (RR = 0.98, p = 0.009); during the same period, the proportion that were carbapenem-resistant Enterobacteriaceae (CRE) decreased 15% per year (RR = 0.85, p
Summary
The emergence and spread of antibiotic resistance threatens to outpace the development of new antimicrobials, and slowing the spread of these organisms has become a priority. Enterobacteriaceae resistance to even broader spectrum antimicrobials, including carbapenems, was reported with increasing frequency beginning in 2001 [3] Rapid spread of these carbapenem-resistant Enterobacteriaceae (CRE) in parts of the United States and other countries [4,5] highlighted a need to more aggressively control CRE transmission. When Enterobacteriaceae with carbapenemases that confer resistance to carbapenem antibiotics emerged, directed control efforts were recommended These distinct approaches could have resulted in differences in spread of these two pathogens. Conclusions: The proportion of Enterobacteriaceae infections that were CRE remained lower and decreased more over time than the proportion that were ESBL phenotype This difference might be explained by the more directed control efforts implemented to slow transmission of CRE than those applied for ESBL-producing strains. Increased detection and aggressive early response to emerging antibiotic resistance threats have the potential to slow further spread
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