Background

Multidrug-resistant (MDR) bacteria that are commonly associated with health care cause a substantial health burden. Updated national estimates for this group of pathogens are needed to inform public health action.

Methods

Using data from patients hospitalized in a cohort of 890 U.S. hospitals during the period 2012–2017, we generated national case counts for both hospital-onset and community-onset infections caused by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum cephalosporin resistance in Enterobacteriaceae suggestive of extended-spectrum beta-lactamase (ESBL) production, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant acinetobacter species, and MDR Pseudomonas aeruginosa.

Results

The hospital cohort in the study accounted for 41.6 million hospitalizations (>20% of U.S. hospitalizations annually). The overall rate of clinical cultures was 292 cultures per 1000 patient-days and was stable throughout the time period. In 2017, these pathogens caused an estimated 622,390 infections (95% confidence interval [CI], 579,125 to 665,655) among hospitalized patients. Of these infections, 517,818 (83%) had their onset in the community, and 104,572 (17%) had their onset in the hospital. MRSA and ESBL infections accounted for the majority of the infections (52% and 32%, respectively). Between 2012 and 2017, the incidence decreased for MRSA infection (from 114.18 to 93.68 cases per 10,000 hospitalizations), VRE infection (from 24.15 to 15.76 per 10,000), carbapenem-resistant acinetobacter species infection (from 3.33 to 2.47 per 10,000), and MDR P. aeruginosa infection (from 13.10 to 9.43 per 10,000), with decreases ranging from −20.5% to −39.2%. The incidence of carbapenem-resistant Enterobacteriaceae infection did not change significantly (from 3.36 to 3.79 cases per 10,000 hospitalizations). The incidence of ESBL infection increased by 53.3% (from 37.55 to 57.12 cases per 10,000 hospitalizations), a change driven by an increase in community-onset cases.

Conclusions

Health care–associated antimicrobial resistance places a substantial burden on patients in the United States. Further work is needed to identify improved interventions for both the inpatient and outpatient settings. (Funded by the Centers for Disease Control and Prevention.)

中文翻译：

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2012-2017 年美国住院患者的多重耐药细菌感染。

 背景

通常与医疗保健相关的多重耐药 (MDR) 细菌会造成巨大的健康负担。需要对这组病原体进行更新的国家估计，以便为公共卫生行动提供信息。

 方法

利用 2012 年至 2017 年期间美国 890 家医院住院患者的数据，我们生成了由耐甲氧西林金黄色葡萄球菌(MRSA)、耐万古霉素肠球菌 (MRSA) 引起的医院发病和社区发病感染的全国病例数。 VRE）、肠杆菌科细菌中的超广谱头孢菌素耐药性提示产生超广谱β-内酰胺酶（ESBL）、耐碳青霉烯类肠杆菌科、耐碳青霉烯类不动杆菌属和耐多药铜绿假单胞菌。

 结果

该研究中的医院队列共有 4160 万人住院（> 每年美国住院人数的 20%）。临床培养的总体率为每 1000 个患者日 292 个培养，并且在整个时间段内保持稳定。 2017 年，这些病原体在住院患者中造成估计 622,390 例感染（95% 置信区间 [CI]，579,125 至 665,655）。在这些感染中，517,818 例（83%）在社区发病，104,572 例（17%）在医院发病。 MRSA 和 ESBL 感染占感染的大部分（分别为 52% 和 32%）。 2012年至2017年间，MRSA感染（从每10,000名住院患者中114.18例降至93.68例）、VRE感染（从每10,000例24.15例降至15.76例）、耐碳青霉烯类不动杆菌属感染（从每10,000例3.33例降至2.47例）和MDR发生率下降铜绿假单胞菌感染（从每 10,000 人 13.10 人减少到 9.43 人），下降幅度为 -20.5% 到 -39.2%。耐碳青霉烯类肠杆菌感染发生率没有显着变化（从每万人住院人数3.36例增加到3.79例）。 ESBL 感染发生率增加了 53.3%（从每万名住院患者 37.55 例增加到 57.12 例），这一变化是由社区发病病例增加所致。

 结论

与医疗保健相关的抗菌药物耐药性给美国患者带来了沉重负担。需要进一步的工作来确定住院和门诊环境的改进干预措施。 （由疾病控制和预防中心资助。）