Hostname: page-component-586b7cd67f-2plfb Total loading time: 0 Render date: 2024-11-23T15:22:59.389Z Has data issue: false hasContentIssue false
  • English
  • Français

Secular Trends in Gram-Negative Resistance among Urinary Tract Infection Hospitalizations in the United States, 2000–2009

Published online by Cambridge University Press:  02 January 2015

Marya D. Zilberberg  and
Andrew F. Shorr
Marya D. Zilberberg*
Affiliation:
EviMed Research Group, Goshen, Massachusetts University of Massachusetts, Amherst, Massachusetts
Andrew F. Shorr
Affiliation:
Washington Hospital Center, Washington, DC
*
PO Box 303, Goshen, MA 01032 (evimedgroup@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Urinary tract infections (UTIs) are common among hospitalized patients. Selection of an appropriate antibiotic for this infection requires knowledge of both its general microbiology and the epidemiology of drug-resistant organisms. We sought to determine secular trends in UTI hospitalizations that involve gram-negative (GN) multidrug-resistant Pseudomonas aeruginosa (MDR-PA), extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae(KP), and carbapenem-resistant Enterobacteriaceae (CRE).

Design.

Survey.

Patients.

Patients with UTI in US hospitals between 2000 and 2009.

Methods.

We first derived the total number of UTI hospitalizations in the United States from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database years 2000–2009. Based on a literature review, we then determined what proportion of all UTIs arise due to each of the organisms of interest, irrespective of resistance pattern. Finally, we assessed the prevalence of resistance within each pathogen based on the Eurofins Surveillance Network database 2000–2009. Susceptibility patterns served as phenotypic surrogates for resistance.

Results.

Between 2000 and 2009, the frequency of UTI hospitalizations increased by approximately 50%, from 53 to 77 cases per 1,000 hospitalizations. Infections due to all GN bacteria followed a similar trajectory, whereas those caused by resistant GN pathogens increased by approximately 50% (MDR-PA) to approximately 300% (ESBL). CRE emerged and reached 0.5 cases per 1,000 hospitalizations in this 10-year period.

Conclusions.

The epidemiology and microbiology of GN UTI hospitalizations has shifted over the past decade. The proportion of all hospitalizations involving this infection has climbed. Resistant GN bacteria are becoming more prevalent and are implicated in an increasing proportion of UTIs among hospitalized patients.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 940 - 946
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Haley, RW, Hooton, TM, Culver, DH, et al.Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients. Am J Med 1981;70:947–959.CrossRefGoogle ScholarPubMed
2.Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol 1985;121:159–167.Google Scholar
3.Saint, S, Meddings, JA, Calfree, D, Kowalski, CP, Krein, SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Int Med 2009;150:877–884.Google Scholar
4.Gandhi, T, Flanders, SA, Markovitz, E, Saint, S, Kaul, DR. Importance of urinary tract infection to antibiotic use among hospitalized patients. Infect Control Hosp Epidemiol 2009;30:193–195.Google Scholar
5.Lewis, JS 2nd, Herrera, M, Wiekes, B, Patterson, JE, Jorgensen, JH. First report of the emergence of CTX-M-type extended-spectrum β-lactamases (ESBLs) as the predominant ESBL isolated in a U.S. health care system. Antimicrob Agents Chemother 2007; 51:4015–4021.CrossRefGoogle Scholar
6.Moland, ES, Hanson, ND, Black, JA, Hossain, A, Song, W, Thomson, KS. Prevalence of newer β-lactamases in gram-negative clinical isolates collected in the United States from 2001 to 2002. J Clin Microbiol 2006;44:3318–3324.Google Scholar
7.Lockhart, SR, Abramson, MA, Beekmann, SE, et al.Antimicrobial resistance among gram-negative bacilli causing infections in intensive care unit patients in the United States between 1993 and 2004. J Clin Microbiol 2007;45:3352–3359.Google Scholar
8.Gaynes, R, Edwards, JR; National Nosocomial Infections Surveillance (NNIS) System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005;41:848–854.Google Scholar
9.Hidron, AI, Edwards, JR, Patel, J, et al.Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hospital Epidemiol 2008;29:996–1011.CrossRefGoogle Scholar
10.Kuehnert, MJ, Hill, HA, Kupronis, BA, Tokars, JI, Solomon, SL, Jernigan, DB. Methicillin-resistant Staphylococcus aureus hospitalizations, United States. Emerg Infect Dis 2005;11:868–872.Google Scholar
11.Klein, E, Smith, DL, Laxminarayan, R. Hospitalizations and deaths caused by methicillin-resistant Staphylococcus aureus, United States, 1999-2005. Emerg Infect Dis 2007. http://wwwnc.cdc.gov/eid/article/13/12/07-0629.htm.Google Scholar
12. Healthcare Cost and Utilization Project (HCUP). HCUP Nationwide Inpatient Sample. Rockville, MD: Agency for Healthcare Research and Quality, 2012. http://www.hcup-us.ahrq.gov/nisoverview.jsp Accessed December 17, 2012.Google Scholar
13.Meddings, J, Saint, S, McMahon, LF. Hospital-acquired catheter-associated urinary tract infection: documentation and coding issues may reduce financial impact of Medicare's new payment policy. Infect Control Hosp Epidemiol 2010;31:627–633.Google Scholar
14.Naber, KG, Llorens, L, Kaniga, K, Kotey, P, Hedrich, D, Redman, R. Intravenous doripenem at 500 milligrams versus levofloxacin at 250 milligrams, with an option to switch to oral therapy, for treatment of complicated lower urinary tract infection and pyelonephritis. Antimicrob Agents Chemother 2009;53:3782–3792.CrossRefGoogle ScholarPubMed
15.Peterson, J, Kaul, S, Khashab, M, Fisher, A, Kahn, JB. Identification and pretherapy susceptibility of pathogens in patients with complicated urinary tract infection or acute pyelonephritis enrolled in a clinical study in the United States from November 2004 through April 2006. Clin Therapeutics 2007;29:2215–2221.Google Scholar
16.Wells, WG, Woods, GL, Jiang, Q, Gesser, RM. Treatment of complicated urinary tract infection in adults: combined analysis of two randomized, double-blind, multicenter trials comparing er-tapenem and ceftriaxone followed by appropriate oral therapy. J Antimicrobial Chemother 2004;53:ii67–ii74.Google Scholar
17.Micek, ST, Kollef, KE, Reichley, RM, et al.Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother 2007;51:3568–3573.Google Scholar
18.Iregui, M, Ward, S, Sherman, G, et al.Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilator-associated pneumonia. Chest 2002;122:262–268.Google Scholar
19.Alvarez-Lerma, F; Intensive Care Unit-Acquired Pneumonia Study Group. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. Intensive Care Med 1996;22:387–394.Google Scholar
20.Zilberberg, MD, Shorr, AF, Micek, MT, Mody, SH, Kollef, MH. Antimicrobial therapy escalation and hospital mortality among patients with HCAP: a single center experience. Chest 2008:134: 963–968.Google Scholar
21.Shorr, AF, Micek, ST, Welch, EC, Doherty, JA, Reichley, RM, Kollef, MH. Inappropriate antibiotic therapy in gram-negative sepsis increases hospital length of stay. Crit Care Med 2011;39:46–51.Google Scholar
22.Kollef, MH, Sherman, G, Ward, S, Fraser, VJ. Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients. Chest 1999;115:462–474.Google Scholar
23.Garnacho-Montero, J, Garcia-Garmendia, JL, Barrero-Almodo-var, A, Jimenez-Jimenez, FJ, Perez-Paredes, C, Ortiz-Leyba, C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med 2003;31:2742–2751.CrossRefGoogle Scholar
24.Harbarth, S, Garbino, J, Pugin, J, Romand, JA, Lew, D, Pittet, D. Inappropriate initial antimicrobial therapy and its effect on survival in a clinical trial of immunomodulating therapy for severe sepsis. Am J Med 2003;115:529–535.Google Scholar
25.Ferrer, R, Artigas, A, Suarez, D, et al.Effectiveness of treatments for severe sepsis: a prospective, multicenter, observational study. Am J Respir Crit Care Med 2009;180:861–866.CrossRefGoogle ScholarPubMed
26.Arias, CA, Murray, BE, Antibiotic-resistant bugs in the 21st century: a clinical super-challenge. N Engl J Med 2009;360:439–443.CrossRefGoogle ScholarPubMed
27.Boucher, H, Talbot, GH, Bradley, JS, et al.Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1–12.Google Scholar