March 01, 2013
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Resistant-bacteria add to bloodstream infection burden

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Recent data suggest that the incidence of bloodstream infections caused by antibiotic-resistant bacteria adds to the burden of bloodstream infections caused by antibiotic-susceptible bacteria, instead of replacing it.

“These results were not surprising, since an additive burden due to antibiotic resistance was often assumed,” Heidi Ammerlaan, MD, PhD, of the University Medical Center Utrecht in the Netherlands, told Infectious Disease News. “However, accurate integrated trend analyses of all relevant nosocomial pathogens have not been performed previously. By comparing longitudinal data from hospitals with high and lower infection rates of antibiotic-resistant bacteria, we took advantage of a natural experiment of successful and less successful control of nosocomial spread of antibiotic-resistant bacteria.”

Heidi Ammerlaan, MD, PhD 

Heidi Ammerlaan

The researchers performed a cohort study of patients with confirmed nosocomial bloodstream infections to determine the incidence of infections caused by methicillin-resistant Staphylococcus aureus, other antibiotic-resistant bacteria and antibiotic-susceptible bacteria. The study included patients at 14 hospitals between 1998 and 2007.

There were 33,130 nosocomial bloodstream infections, of which 14% were caused by antibiotic-resistant bacteria. From 1998 to 2007, the average incidence density of nosocomial bloodstream infections varied per hospital, ranging from 62.3 per 100,000 patient-days to 185.5 per 100,000 patient-days. The annual incidence densities increased in 12 of the 14 hospitals.

Hospitals non-endemic for antibiotic-resistant bacteria saw an annual increase of MRSA of 22% (95% CI, 6-40), and endemic hospitals saw an annual increase of 10% (95% CI, 9-12). The incidence of non-MRSA bloodstream infections increased by 5% (95% CI, 1-9) in non-endemic hospitals and 22% (95% CI, 20-25) in endemic hospitals. The trends in antibiotic-sensitive bacteria incidence were similar in both endemic and non-endemic hospitals, with annual increases of 4.2% and 4.5%, respectively. 

“These data imply that successful control of antibiotic resistance improves patient outcomes not only because of lower mortality from better, treatable infections, but also because of a reduction, or at least a lower increase, in the number of infections. This information is critical for estimating costs and assessing the benefits of infection prevention and control strategies, which we will continue to determine in future research.”

Disclosure: Ammerlaan reports no relevant financial disclosures.