December 04, 2019
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Antibiotic resistance more common in device-associated HAIs than SSIs

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Hilary Babcock, MD, MPH
Hilary Babcock

Health care-associated infections, or HAIs, related to the use of medical devices are more likely to be antibiotic resistant than those resulting from surgical procedures, with antimicrobial nonsusceptibility more common among adults than children, according to data from the CDC’s National Healthcare Safety Network.

“The data show that bacteria that are resistant to antibiotics are prevalent in hospitals and health systems across the country, and especially in places where we treat our most vulnerable patients,” Hilary Babcock, MD, MPH, president of the Society for Healthcare Epidemiology of America, told Healio. “We need to ensure effective infection prevention and control, as well as antibiotic stewardship programs, are being utilized to maximize patient safety and improve outcomes.”

The first of two reports published in Infection Control & Hospital Epidemiology summarized adult HAI surveillance from 5,626 facilities between 2015 and 2017. Researchers examined data on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events and surgical site infections (SSIs) from acute-care hospitals, long-term acute-care hospitals and inpatient rehabilitation facilities.

A second study examined antimicrobial resistance data for pathogens implicated in CLABSIs, CAUTIs, ventilator-associated pneumonias and SSIs among children aged younger than 18 years in 2,545 facilities.

Among adults, researchers found that Escherichia coli (18%), Staphylococcus aureus (12%) and Klebsiella species (9%) were the most frequently reported pathogens. According to the report, pathogens varied by HAI and location type, with oncology units having a more distinct pathogen distribution. Additionally, they found that pathogen nonsusceptibility was significantly more common among device-associated HAIs compared with SSIs, and from long-term acute-care hospitals compared with general hospital wards.

For example, 48.4% of device-associated S. aureus isolates were MRSA, compared with 41% of those isolated from surgical site infections. And 82.1% of device-associated Enterococcus faecium bacteria were resistant to vancomycin, compared with 55.6% among SSIs.

Among pediatric patients, researchers found that S. aureus (15%), E. coli (12%), and coagulase-negative staphylococci (12%) were the most commonly reported pathogens associated with pediatric HAIs. According to the report, among CLABSIs, the percentages of pathogens with nonsusceptibility was generally lowest in neonatal intensive care units and highest in pediatric oncology units, the researchers reported. Additionally, Staphylococcus species were particularly common among orthopedic, neurosurgical and cardiac SSIs, although E. coli was more common in abdominal SSIs.

“These findings offer insight into where and what type of antibiotic resistant infections are occurring,” Babcock said. “Health care professionals should be closely reviewing their local data to understand the common pathogens and resistance patterns associated with infections, and work to create infection prevention policies that target these pathogens and antimicrobial stewardship programs to improve prescribing practices.”– by Caitlyn Stulpin

Disclosure: Babcock reports no relevant financial disclosures.