National Prevalence of Multidrug-resistant Organisms High in Nonacute-care Setting

Vikas Gupta, PharmD, BCPS, director of Clinical Strategy at Becton Dickinson, discusses the results of his research into the national prevalence of multidrug-resistant organisms.

Interview Transcript (slightly modified for readability)

“We started out looking at percent nonsusceptible within 348 hospitals. We’ve been doing a rolling four-quarter analysis, so every quarter we do new projections because some of these resistance patterns regionally may change. We started out looking at observed rates. What we found is that the rates, meaning percent nonsusceptible or multidrug-resistant, is highest in the hospital-onset setting. That wasn’t surprising to us; but then, when we started looking at the sheer numbers of these case nonduplicate episodes, [we saw] much, much greater prevalence in the observed cases across our 348 hospitals within that nonacute-care setting.

When we, then, applied our statistical methodologies to project the national prevalence, we were struck by how much is in the nonacute-care setting. It’s not unusual for us to see, for example, with ESBL-producing organisms, multidrug-resistant Enterobacteriaceae, we were seeing upwards of 50% [to more than] 60% in the nonacute-care setting, even though the actual percent nonsusceptible, or multidrug-resistance is highest in the hospital-onset setting. That struck us. Then, we further looked into the sources of these, and we found differences in sources.

ESBL is very high in the ambulatory setting, not surprisingly, in the urine source, [with] upwards of 85% to 88% [prevalence] in the urine source; but, as we, then, looked at transition patients [from whom] the isolates were collected in the admission period in hospital-onset, we were seeing other sources; [prevalence in] urine was less, but still more than 50%.

We also saw differences in the types of multidrug resistances we looked at. For example, [with] Acinetobacter one would see more resistance in the hospital-onset setting. That’s what we saw, that Acinetobacter was much higher in that admission period and hospital-onset period; but, we were still seeing multidrug-resistant Acinetobacter in the nonacute-care or ambulatory setting as well.

We also saw regional differences, with Midwest and South being highest when we look at actual projected numbers of these cases, or nonduplicate episodes as well. A lot more in the ambulatory setting as I stated as well.”