Archive for April 4, 2018

Containment of Novel Multidrug-Resistant Organisms and Resistance Mechanisms — United States, 2006–2017

MMWR Early Release  April 03, 2018 V.67

Kate Russell Woodworth, MD; Maroya Spalding Walters, PhD; Lindsey M. Weiner, MPH; et al.

The proportion of Enterobacteriaceae infections that were carbapenem resistant remained lower and decreased more over time than the proportion that were extended-spectrum-ß-lactamase phenotype. Data suggest the potential to slow further spread of emerging antibiotic resistance threats through increased detection and early aggressive response.

Background

Approaches 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.

Methods

Infection 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.

Results

The 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.

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.

FULL TEXT

https://www.cdc.gov/mmwr/volumes/67/wr/mm6713e1.htm?s_cid=mm6713e1_e

PDF

https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6713e1-H.pdf

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April 4, 2018 at 8:02 am


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