Hospitals Appear to Make Progress Against MDR Infections, Though Burden Remains High

Multidrug-resistant bacteria remain a major burden on the US health care system, though a new report says there are signs mitigation efforts at local health care facilities are having an impact.

The study, published in The New England Journal of Medicine, relied on data from 890 US hospitals from 2012 through 2017. Over that period, the overall rate of clinical cultures remained steady, at 292 cultures per 1000 patient days.

The causes of infection included in the analysis were: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum β-lactamase (ESBL) production, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter species, and multidrug-resistant (MDR) Pseudomonas aeruginosa.

The overall picture was a positive trend over the course of the study, and in the final year of the analysis, hospitals reported a total of 622,390 infections. Of those, 83% were believed to have had their onset in the community, leaving about 104,000 infections that appear to have occurred in health care facilities.

In an email, lead author John A. Jernigan, MD, of the US Centers for Disease Control and Prevention’s Division of Health Care Quality Promotion, said while the study wasn’t designed to ascertain the specific reasons for the improvements, it appears hospital-based efforts have been effective.

“During the past decade health care decision makers have placed increased emphasis on infection control in health care, including efforts to improve implementation of strategies for preventing device- and procedure-related infections and general infection control measures such as hand hygiene,” Jernigan said, adding that many MDR organism-specific measures have been put into place at hospitals, as well as in antimicrobial stewardship programs.

The biggest overall drop was in infections caused by VRE, which fell by 39.2% over the course of the study. In total, 4 of the 6 pathogens had decreasing numbers of cases. However, Jernigan and colleagues found the incidence of CRE was stable, and the incidence of ESBL actually increased by 53.3%, though most of that increase was in community-derived cases.

The authors noted that the spike could also be due to the pathogen’s distinct epidemiological characteristics, which vary from the other pathogens studied.

Jernigan said more work is needed to determine which infection-fighting tactics work best, and how best to implement them. He also said the health care system will need new and more effective antibiotics, as well as better antibiotic stewardship.

“To achieve maximal impact, current and future efforts should be coordinated at the regional level through clinical and public health partnerships, informed by vigilant monitoring of established threats, and early identification of emerging threats,” Jernigan said.

“Innovative interventions and strategies, tailored for the spectrum of health care and community settings, will be needed to sustain progress in combating antibiotic resistance.”

Jernigan emphasized that the main message for health care professionals is that infection control and antibiotic stewardship remain critically important.

“I would encourage hospital staff to remember that in the battle against antibiotic resistance, those little things they do every day to prevent infection, like performing hand hygiene, or following contact precautions when indicated, are making a big difference,” he explained.