Superbugs Threaten Hospital Patients

Health care–associated infections (HAIs) remain a leading cause of morbidity and mortality in the United States. Although the United States is doing a better job of preventing HAIs, more work is needed, especially in fighting antibiotic-resistant bacteria, public health officials said.

The Centers for Disease Control and Prevention’s latest Vital Signs report urges health care workers to use a combination of infection control recommendations to better protect patients from these infections.

“New data show that far too many patients are getting infected with dangerous, drug-resistant bacteria in health care settings,” said Tom Frieden, MD, MPH, the director of the Centers for Disease Control and Prevention (CDC). “Doctors and health care facilities have the power to protect patients. No one should get sick while trying to get well.”

Many of the most urgent and serious antibiotic-resistant bacteria threaten patients while they are being treated in health care facilities for other conditions, and may lead to sepsis or death. In acute care hospitals, one in seven catheter- and surgery-related health care–associated infections can be caused by any of the six antibiotic-resistant bacteria listed below. That number increases to one in four infections in long-term acute care hospitals, which treat patients who are generally very sick and stay, on average, more than 25 days.

The six antibiotic-resistant threats examined are:

Carbapenem-resistant Enterobacteriaceae (CRE)

Methicillin-resistant Staphylococcus aureus (MRSA)

ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases)

Vancomycin-resistant enterococci (VRE)

Multidrug-resistant Pseudomonas aeruginosa

Multidrug-resistant Acinetobacter

 

Hospitals Better at Preventing Most HAIs

The national data in today’s Vital Signs report, along with data from the CDC’s latest annual progress report on HAI prevention, show the following:

A 50% decrease in central line–associated bloodstream infections (CLABSIs) between 2008 and 2014.

One in six remaining CLABSIs are caused by urgent or serious antibiotic-resistant bacteria.

A 17% decrease in surgical site infections (SSIs) between 2008 and 2014 related to 10 procedures tracked in previous HAI progress reports.

One in seven remaining SSIs are caused by urgent or serious antibiotic-resistant bacteria.

One in 10 catheter-associated urinary tract infections (CAUTIs) are caused by urgent or serious antibiotic-resistant bacteria.

There has been no change in overall catheter-associated urinary tract infections (CAUTIs) between 2009 and 2014. During this time, however, there was progress in non-ICU settings, progress in all settings between 2013 and 2014, and most notably, even more progress in all settings toward the end of 2014.

The report also examined the role of Clostridium difficile, the most common type of bacteria responsible for infections in hospitals. C. difficile caused almost half a million infections in the United States in 2011 alone. The CDC’s annual progress report shows that progress has been made in decreasing hospital-onset C. difficile infections by 8% between 2011 and 2014.

Along with the updated annual progress report, the CDC released the Antibiotic Resistance Patient Safety Atlas, a new Web app with interactive data on HAIs caused by antibiotic-resistant bacteria. The tool provides national, regional and state map views of superbug/drug combinations showing percent resistance over time. The atlas uses data reported to the CDC’s National Healthcare Safety Network from 2011 to 2014, from more than 4,000 health care facilities.

The CDC called on health care professionals to do their part to prevent HAIs by combining three critical efforts to accomplish this:

• Prevent the spread of bacteria among patients;
• Prevent infections related to surgery and/or placement of a catheter; and
• Improve antibiotic use through stewardship.

“For clinicians, prevention means isolating patients when necessary,” said Clifford McDonald, MD, the associate director for science at the CDC’s Division of Healthcare Quality Promotion. “It also means being aware of antibiotic resistance patterns in your facilities, following recommendations for preventing infections that can occur after surgery or from central lines and catheters placed in the body, and prescribing antibiotics correctly.”

The CDC’s efforts, in addition to efforts by the Centers for Medicare & Medicaid Services (CMS), the Agency for Healthcare Research and Quality (AHRQ) and state mandates for public reporting of HAIs, have all contributed to national progress in improving transparency, accountability and quality related to patient safety.

“The good news is that we are preventing health care–acquired infections, which has saved thousands of lives,” said Patrick Conway, MD, MSc, the deputy administrator and chief medical officer at CMS. “The challenge ahead is how we help to prevent antibiotic resistance as well as infections. We are using incentives, changes in care delivery and transparency to improve safety and quality for patients.”

Congress has recognized the urgent need to combat antibiotic resistance. In fiscal year 2016, Congress appropriated $160 million in new funding for the CDC to implement its activities listed in the National Action Plan for Combating Antibiotic-Resistant Bacteria.