Abstract for SHEA 18th Annual Scientific Meeting
Antimicrobial Resistant Pathogens Associated with Healthcare-Acquired Infections
(HAIs) Reported to the CDC's National Healthcare Safety Network (NHSN), 2006-2007.
Alicia I. Hidron, MD1, Jonathan R. Edwards, MS2, Jean Patel, PhD2, Teresa C. Horan, MPH2, Daniel Pollock, MD2, Scott K. Fridkin, MD2, for the NHSN Team and Participating Facilities.Author's affiliations: 1.Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA 2.Centers for Disease Control and Prevention, Division of Healthcare Quality Promotion, Atlanta, GA
Background. The NHSN replaced the National Nosocomial Infections Surveillance System in 2005. It and includes reports from more types of facilities and patient care areas.
Objective. To describe the frequency of select antimicrobial resistance patterns among pathogens reported to NHSN from January 2006 (first month of full data availability) to October 2007.
Methods. All pathogens from HAIs reported to the Patient Safety Module (catheter-associated bloodstream infections [CLABSI], ventilator-associated pneumonia [VAP], catheter-associated urinary tract infection [CAUTI], surgical site infection [SSI], and post-procedure pneumonia [PPP]), were included. Pooled mean percents of select pathogens testing resistant to select antimicrobials were calculated by type of HAI and overall.
Results. Overall, 463 hospitals reported = 1 infection; 89% were general acute care hospitals, 217 (47%) had 200-500 beds, 151 (33%) reported < 200 beds. For 20,299 patients, 23,167 device-associated HAIs were reported from 1,040 unique patient-care areas including 6 ICU types (23% medical-surgical, 13% medical, 12% surgical, 11% neonatal, 7% trauma, 6% cardiothoracic) and non-ICU wards (12%). Only 40 PPP were reported, but 5,291 SSIs were reported mostly following cardiac (29%), abdominal (26%), and orthopedic (18%) procedures. The most frequently reported pathogens by type of HAI are listed in Table 1. Among device-related infections, the rates of the following resistant isolates were similar: MRSA (56% of S. aureus); VRE (80% of E. faecium; 7% of E. faecalis); P. aeruginosa resistant to ceftazidime and quninolones, or, piperacillin, or carbapenems (30%, 17%, and 25% of P. aeruginosa respectively). Differences were noted for carbapenem resistant gram-negatives: carbapenem-resistant A. baumannii were more common among VAP (37%) than either CLABSI (29%) or CAUTI (26%), and carbapenem-resistant K. pneumoniae were more common among CLABSI (10%) and CAUTI (10%) than VAP (4%) (p <0.05). Among SSIs, MRSA was 49% and VRE was 57% (E. faecium). Among all infections reported, problematic resistant pathogens account for a minority of infections (11% Candida spp., 8% MRSA, 4%VRE (E. faecium), 1% carbapenem resistant A. baumannii).
Conclusion. Initial data reported to NHSN demonstrated rates of resistance slightly different from that reported in recent publications from the U.S., including higher resistance to carbapenems and slightly lower MRSA. Evaluating the impact of newly participating NHSN hospitals on resistance rates is ongoing.
Table 1. Distribution of top ranking pathogens associated with NHSN reportable HAIs; January 2006 - October 2007 |
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| Pathogen (n= 33,848) (25,502 infections) | CLABSI | CAUTI | VAP | SSI | Total * | |||||
|---|---|---|---|---|---|---|---|---|---|---|
N |
% |
N |
% |
N |
% |
N |
% |
N |
% |
|
| A. baumannii | 252 |
2.21 |
109 |
1.16 |
498 |
8.36 |
42 |
0.60 |
902 |
2.66 |
| CoNS | 3900 |
34.13 |
234 |
2.50 |
79 |
1.33 |
965 |
13.74 |
5178 |
15.30 |
| Candida spp. | 1342 |
11.74 |
1974 |
21.05 |
160 |
2.69 |
145 |
2.07 |
3628 |
1072 |
| E. coli | 310 |
2.71 |
2009 |
21.42 |
271 |
4.55 |
671 |
9.55 |
3264 |
9.64 |
| Enterococcus spp. | 1834 |
16.05 |
1393 |
14.85 |
77 |
1.29 |
788 |
11.21 |
4093 |
12.10 |
| Enterobacter spp. | 443 |
3.88 |
384 |
4.10 |
498 |
8.36 |
293 |
4.17 |
1624 |
4.80 |
| P. aeruginosa | 357 |
3.12 |
938 |
10.00 |
972 |
16.31 |
390 |
5.55 |
2664 |
7.87 |
| S. aureus | 1127 |
9.86 |
208 |
2.22 |
1456 |
24.43 |
2108 |
30.01 |
4913 |
14.51 |
* Total reflects post procedure pneumonia event as well (not included in this table) |
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Content source:
Division of Healthcare Quality Promotion (DHQP)
National Center for Preparedness, Detection, and Control of Infectious Diseases