916 - National Estimates of the Proportion of Bacterial Pathogens Expressing Resistant Phenotypes in US Hospitals, 2012-2017

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Presenting Author(s)

James Baggs

Epidemiologist
CDC
atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

KH

Kelly M. Hatfield

Epidemiologist
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HW

Hannah Wolford

Health Scientist
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
BO

Babatunde Olubajo

Principal Health Research Analyst
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sujan Reddy

Medical Director of CDC’s Prevention Epicenter Program
CDC
Atlanta, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Natalie McCarthy

Epidemiologist
CDC
Atlanta, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
PP

Prabasaj Paul

Epidemiologist
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CM

Clifford McDonald

Associate Director for Science
Centers for Disease Control and Prevention
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AK

Alexander Kallen

Branch Chief
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Anthony Fiore

Branch Chief
DIv of Healthcare Quality Promotion
Atlanta, GA
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
John A. Jernigan

Director, Office of Prevention Research and Evaluation
CDC
Atlanta, Georgia
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: In 2019, CDC updated national estimates of antibiotic resistance. In this abstract we provide national estimates of and trends in proportion of bacterial pathogens expressing resistant phenotypes (%R), specifically: MRSA, VRE, CRE, ESBL, CRAsp, and MDR Pseudomonas, see Figure.Figure: National Estimates and Adjusted Trends of % Resistance, by Pathogen

Methods: We measured incidence of clinical cultures yielding the bacterial species of interest among hospitalized adults in hospitals submitting data to the Premier Healthcare Database, Cerner Health Facts and BD Insights Research Database from 2012- 2017. Community-onset (CO) cultures were obtained ≤ day 3 of hospitalization; hospital-onset (HO) were obtained ≥ day 4. We determined hospital-specific %R for each species. We generated national estimates using a raking procedure to generate weighted adjustments to match the distribution for all U.S. acute care hospitals based on U.S. census division, bed size, teaching status, and urban/rural designation. We applied a weighted means survey procedure to calculate national estimates for each year. We used weighted multivariable logistic regression adjusting for hospital characteristics to examine trends.

Results: From 2012-2017, the overall number of hospitals contributing data was 890 (over 20% of U.S. hospital hospitalizations annually). National estimates and trends of %R are shown in the Figure. Between 2012-2017, significant annual decreases in %R were observed for MRSA, VRE, CRAsp, and MDR Pseudomonas. CRE %R did not change. Overall ESBL %R increased by 44% (CO=49% increase, HO=27% increase).

Conclusion: Reductions in %R were observed among MRSA, VRE, CRAsp, and MDR Pseudomonas, suggesting that prevention efforts focused in health care settings are having a disproportionate effect on resistant strains. However, %R remains unacceptably high for all pathogens we studied, and %R among ESBL-producing Enterobacteriaceae has increased, most prominently among CO infections. Continued focus on currently recommended intervention strategies as well as new ones for community onset infections is needed.