Infected medical devices main source of Antibiotic resistance-CDC report

Infections related to medical devices are a key source of antibiotic resistance than infections associated with surgical procedures.

USA: According to a report by the US Centers for Disease Control and Prevention (CDC), antibiotic resistance is more prevalent in healthcare-associated infections (HAIs) related to the use of medical devices than in HAI associated with surgical procedures. The report is published in the journal Infection Control & Hospital Epidemiology.

Also, HAIs acquired in long-term acute care facilities are more likely to be antibiotic-resistant than those in short-stay acute care hospitals, while data from a separate report indicates that antibiotic resistance is more prevalent in adult HAIs than it is in pediatric hospital infections.

The report underscores the importance of tracking antimicrobial resistance, particularly in vulnerable populations such as long-term acute-care hospitals and intensive care units.

“These data show that the threat of exposure to bacteria that are resistant to antibiotics extends across the nation. The data also serve as an urgent call for healthcare facilities and public health agencies to intensify their efforts to prevent the emergence and spread of antimicrobial resistance," said Lindsey Weiner-Lastinger, an epidemiologist at the CDC.

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The study by Lastinger and colleagues aimed to describe common pathogens and antimicrobial resistance patterns for healthcare-associated infections (HAIs) that occurred during 2015–2017 and were reported to the Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN).

The study involved data from more than 5,600 hospitals in the CDC's National Healthcare Safety Network (NHSN). The data cover central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), and surgical-site infections (SSIs) reported to the NHSN by 5,626 acute care hospitals, long-term acute care hospitals, and inpatient rehabilitation facilities from 2015 through 2017. The report is the fourth summary of NHSN pathogen and antibiotic susceptibility data, and the CDC's most detailed HAI surveillance effort to date.

The data can be used to help hospitals improve infection control and prevention strategies and provide direction for new drug development.

In their analysis, CDC researchers identified the most commonly reported pathogens associated with these infections, and for each HAI type and each location, calculated the percentage of pathogens with nonsusceptibility to selected antibiotics. Device-associated HAIs and the pathogens connected with them were stratified by hospital ward.

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Key findings of the study include:

• Germs in adult and pediatric facilities varied by infection type and care location.
• The most common HAI bacteria among adult patients were Escherichia coli (18%), Staphylococcus aureus (12%) and Klebsiella (9%).
• A companion report on pediatric healthcare-associated infections, with data from 2,454 facilities, found the most prevalent pathogens among pediatric patients were Staphylococcus aureus (15%), Escherichia coli (12%), and coagulase-negative staphylococci (12%).
• The data also show that bacteria associated with long-term acute care hospitals are more likely to be antibiotic-resistant than those acquired in short-stay acute care hospitals, and HAIs in adult healthcare settings are more likely to be resistant than those in pediatrics.
• Analysis of antimicrobial nonsusceptibility revealed that, for most pathogens, resistance was higher for the device-associated HAIs than for surgical site infections (SSIs).
• The biggest difference was observed in infections associated with Enterococcus faecium; 82% of E faecium bacteria from device-associated HAIs were nonsusceptible to vancomycin, compared with 56% of E faecium among SSIs.
• Statistically significant differences were also found in infections caused by methicillin-resistant S aureus (48% resistant in device-associated HAIs compared with 41% resistant in SSIs) and fluoroquinolone-resistant E coli (38% vs 32%).

Lastinger said the increasing availability of clinical and laboratory data in electronic form provides new opportunities to quickly identify resistance to antibiotic therapies and to inform antibiotic stewardship programs. Appropriate resources should be allocated to ensure proper infection prevention methods of devices and the environment across the healthcare continuum.

The study, "Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017," is published in the journal Infection Control & Hospital Epidemiology.