CDC: Antibiotic-resistant bugs on rise in ICUs
MRSA, VRE continue to climb in sentinel ICUs
Data from Centers for Disease Control and Prevention sentinel hospitals reveal a "concerning and continuing increase" in antibiotic-resistant nosocomial infections in intensive care units.1 Your facility’s infection control practices may play a role. (See related story, p. 55.)
Posted on the Internet, the surveillance report summarizes the rates of antimicrobial resistance among selected pathogens identified from ICU patients with nosocomial infections in the CDC National Nosocomial Infections Surveillance (NNIS) system. The CDC compared the percentage increase in resistant rates for the period of January-November 1998 with the average rate of resistance for each pathogen over the previous five years (1993-1997).
The highest percentage increases in resistance for 1998 vs. 1993-1997 were for vancomycin-resistant enterococci (55%), methicillin-resistant Staphylococcus aureus (31%), and quinolone resistance in Pseudomonas aeruginosa (89%).
The pathogens were selected for their public health importance or because they are known to be common causes of nosocomial infections (i.e., VRE, MRSA), explains Scott Fridkin, MD, medical epidemiologist for nosocomial infection surveillance activity in the CDC hospital infections program. The CDC released the analysis in part to respond to frequent inquiries about national antibiotic resistance rates.
"It is really an attempt to coordinate our response to the public and to the infection control community on resistance," he says. "It is the best possible comparable rates we can come up with because we are focusing on a specific patient population. It is not a representative sample of all of the patients in the U.S."
The combination of prudent use of antibiotics and infection control measures with drug-resistant infections has been much emphasized in guidelines and studies over the last few years, but Fridkin says one cannot simply conclude the measures are not working based on the NNIS data. The analysis did not attempt to factor in the level and variety of infection control guidelines and antibiotic controls used in the NNIS hospitals and ICUs.
"What it does say, though, is that in this patient population — the ICU patient — the problem of resistance is continuing despite some warnings and revised recommendations," he says.
Similarly, the data are not risk-adjusted, and should be used with caution in interfacility comparisons, the CDC reminds. However, infection control professionals can make "a reasonable comparison" in looking at the CDC rates of resistance and those found in their own ICUs, Fridkin notes. Plans call for an update of the analysis every six months, so increases and declines in antibiotic-resistant infections can be tracked on an ongoing basis. In some cases, the level of overall resistance is so high that simply holding the status quo will be little cause for celebration. For example, while methicillin resistance in coagulase-negative staph ylococci increased only 2% in 1998 compared with the prior five-year average, a striking 85.7% of the 2,553 isolates causing infections were resistant. In comparison, P. aeruginosa infections resistant to third-generation cephalosporins also increased only marginally (1%) in the two comparative periods, but a much lower percentage (21%) of the 1,931 isolates were resistant.
"Are we going in the right or wrong direction?" Fridkin says. "For all of these, they are still moving up. That is the point you can take away."
Reference
1. Centers for Disease Control and Prevention. Selected antimicrobial resistant pathogens associated with nosocomial infections in intensive care unit patients, comparison of resistant rates from January-November 1998 with 1993-1997. National Nosocomial Infections Surveillance System.
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