N10. MDRO-GNR/emerging resistant bacterial pathogens

Oral Abstract Submission

2850 - Burden of Difficult-to-Treat Antibiotic-Resistant (DTR) Gram-negative Infections in the United States, 2012-2017

Presenting Author(s)

• SK

  Sameer S. Kadri, MD, MS

  Head, Clinical Epidemiology Section, Critical Care Medicine Department
  National Institutes of Health
  Bethesda, MD

  Disclosure: Nothing to disclose

Co-Author(s)

• JB

  James Baggs, PhD

  Epidemiologist
  Centers for Disease Control and Prevention
  Atlanta, GA

  Disclosure: Nothing to disclose
• 

  Sarah H. Yi, PhD, MS

  Health Scientist
  Centers for Disease Control and Prevention
  Atlanta, GA

  Disclosure: Nothing to disclose
• JS

  Jeffrey R. Strich, MD

  Staff Clinician
  National Institutes of Health
  Bethesda, MD

  Disclosure: Nothing to disclose
• YL

  Yi Ling Lai, MPH

  Data Manager
  National Institute of Allergy and Infectious Diseases
  Bethesda, MD

  Disclosure: Nothing to disclose
• ER

  Emily Ricotta, PhD, ScM

  Epidemiologist, Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research
  National Institute of Allergy and Infectious Diseases
  Bethesda, MD

  Disclosure: Nothing to disclose
• DP

  D. Rebecca Prevots, PhD

  Head, Epidemiology Unit, Laboratory of Clinical Immunology and Microbiology, Division of Intramural Research
  National Institute of Allergy and Infectious Diseases
  Bethesda, MD

  Disclosure: Nothing to disclose
• RD

  Robert L. Danner, MD

  Senior Investigator
  National Institutes of Health
  Bethesda, MD

  Disclosure: Nothing to disclose
• HW

  Hannah Wolford, MSPH

  Scientific Data Analyst
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: Nothing to disclose
• BO

  Babatunde Olubajo, PhD, MPH

  Principal Health Research Analyst
  Centers for Disease Control and Prevention
  Atlanta, GA

  Disclosure: Nothing to disclose
• KH

  Kelly M. Hatfield, MSPH

  Epidemiologist
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: Nothing to disclose
• 

  Sujan Reddy, MD, MSc

  Medical Director of CDC’s Prevention Epicenter Program
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: Nothing to disclose
• JJ

  John A. Jernigan, MD, MS

  Director, Office of Prevention Research and Evaluation
  Centers for Disease Control and Prevention
  Atlanta, Georgia

  Disclosure: Nothing to disclose

Background : Difficult-to-Treat Resistance (DTR) is a metric for clinically-relevant “pan-resistance” to available high-efficacy, low-toxicity antibiotic treatment options at any given time. Previous DTR prevalence estimates in gram negative (GN) bloodstream isolates from 2009 to 2014 have ranged between 1-1.5%. We sought to estimate the national burden of DTR GN isolates and more recent trends by region, site and species.

Methods : Clinical cultures with GN isolates were identified from inpatient encounters in hospitals reporting at least 1 culture with susceptibility testing for a given month to Premier Healthcare Database or Cerner Health Facts Database from 2012-2017. DTR was defined as intermediate susceptibility or resistance to all tested carbapenems, other b-lactams, and fluoroquinolones, but not including agents introduced 2014 onwards. For each year, a raking procedure generated weights to extrapolate the sample estimate to match American Hospital Association distributions based on U.S. census division, hospital bed capacity, teaching status, and urban designation. A weighted means survey procedure was used to extrapolate the sample estimate to obtain national DTR burden. Trends in DTR incidence were examined by using weighted multivariable logistic regression.

Results : Extrapolating from a 373-hospital sample, the estimated 2017 U.S. inpatient burden of DTR isolates was 3,315 (1.3%) among sterile-site and 31,509 (1.7%) among all cultures, ranging from 0.5% to 3.3% in Mountain and New England regions respectively. P. aeruginosa was the most common species overall (37%), while A. baumannii was most common among sterile sites (31%). Between 2012-2017, there was no annual percent change in DTR incidence for sterile sites [OR 0.99 (0.93, 1.06)] but for all cultures it decreased 4.1% annually [OR 0.95 (0.91, 0.99)], including 9% annually for A. baumannii [OR 0.905 (0.860, 0.953)] and K. pneumonia [OR 0.903 (0.824, 0.991)] respectively.

Conclusion : The U.S. inpatient burden of GN isolates displaying DTR is relatively low, varies by region and has remained stable or declined slightly in recent years. Periodic inclusion of emerging antibiotics in the DTR classification will allow for a dynamic index between resistance and available agents.