title: Evaluating state-specific antibiotic resistance measures derived from central line-associated bloodstream infections, national healthcare safety network, 2011.
abstract: DISCLOSURE The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Agency for Toxic Substances and Diseases Registry. OBJECTIVE Describe the impact of standardizing state-specific summary measures of antibiotic resistance that inform regional interventions to reduce transmission of resistant pathogens in healthcare settings. DESIGN Analysis of public health surveillance data. METHODS Central line-associated bloodstream infection (CLABSI) data from intensive care units (ICUs) of facilities reporting to the National Healthcare Safety Network in 2011 were analyzed. For CLABSI due to methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum cephalosporin (ESC)-nonsusceptible Klebsiella species, and carbapenem-nonsusceptible Klebsiella species, we computed 3 state-level summary measures of nonsusceptibility: crude percent nonsusceptible, model-based adjusted percent nonsusceptible, and crude infection incidence rate. RESULTS Overall, 1,791 facilities reported CLABSIs from ICU patients. Of 1,618 S. aureus CLABSIs with methicillin-susceptibility test results, 791 (48.9%) were due to MRSA. Of 756 Klebsiella CLABSIs with ESC-susceptibility test results, 209 (27.7%) were due to ESC-nonsusceptible Klebsiella, and among 661 Klebsiella CLABSI with carbapenem susceptibility test results, 70 (10.6%) were due to carbapenem-nonsusceptible Klebsiella. All 3 state-specific measures demonstrated variability in magnitude by state. Adjusted measures, with few exceptions, were not appreciably different from crude values for any phenotypes. When linking values of crude and adjusted percent nonsusceptible by state, a state's absolute rank shifted slightly for MRSA in 5 instances and only once each for ESC-nonsusceptible and carbapenem-nonsusceptible Klebsiella species. Infection incidence measures correlated strongly with both percent nonsusceptibility measures. CONCLUSIONS Crude state-level summary measures, based on existing NHSN CLABSI data, may suffice to assess geographic variability in antibiotic resistance. As additional variables related to antibiotic resistance become available, risk-adjusted summary measures are preferable.
authors: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,1600 Clifton Road,NE,Atlanta,Georgia.
authors: Minn M
authors: MM
authors: Soe
authors: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,1600 Clifton Road,NE,Atlanta,Georgia.
authors: Jonathan R
authors: JR
authors: Edwards
authors: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,1600 Clifton Road,NE,Atlanta,Georgia.
authors: Dawn M
authors: DM
authors: Sievert
authors: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,1600 Clifton Road,NE,Atlanta,Georgia.
authors: Philip M
authors: PM
authors: Ricks
authors: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,1600 Clifton Road,NE,Atlanta,Georgia.
authors: Shelley S
authors: SS
authors: Magill
authors: Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,1600 Clifton Road,NE,Atlanta,Georgia.
authors: Scott K
authors: SK
authors: Fridkin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D015780:Carbapenems / Q000494:pharmacology; D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D018563:Disease Notification; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D041121:Klebsiella oxytoca / Q000187:drug effects; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D062486:Public Health Surveillance; D020379:Risk Adjustment / Q000379:methods*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D014481:United States; D055815:Young Adult
chemical_list: D015780:Carbapenems
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