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Secular trends in gram-negative resistance among urinary tract infection hospitalizations in the United States, 2000-2009.

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Citation: Infection Control & Hospital Epidemiology. 34(9):940-6, 2013 Sep.PMID: 23917908Institution: MedStar Washington Hospital CenterDepartment: Medicine/Pulmonary-Critical CareForm of publication: Journal ArticleMedline article type(s): Journal Article | Research Support, Non-U.S. Gov'tSubject headings: *Gram-Negative Bacterial Infections/mi [Microbiology] | *Hospitalization/sn [Statistics & Numerical Data] | *Urinary Tract Infections/mi [Microbiology] | Cross Infection/dt [Drug Therapy] | Cross Infection/ep [Epidemiology] | Cross Infection/mi [Microbiology] | Drug Resistance, Bacterial | Drug Resistance, Multiple, Bacterial | Escherichia coli Infections/dt [Drug Therapy] | Escherichia coli Infections/ep [Epidemiology] | Escherichia coli Infections/mi [Microbiology] | Gram-Negative Bacterial Infections/dt [Drug Therapy] | Gram-Negative Bacterial Infections/ep [Epidemiology] | Humans | Klebsiella Infections/dt [Drug Therapy] | Klebsiella Infections/ep [Epidemiology] | Klebsiella Infections/mi [Microbiology] | Pseudomonas Infections/dt [Drug Therapy] | Pseudomonas Infections/ep [Epidemiology] | Pseudomonas Infections/mi [Microbiology] | United States/ep [Epidemiology] | Urinary Tract Infections/dt [Drug Therapy] | Urinary Tract Infections/ep [Epidemiology]Year: 2013 Local holdings: Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006ISSN:

0899-823X

Name of journal: Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of AmericaAbstract: CONCLUSIONS: The epidemiology and microbiology of GN UTI hospitalizations has shifted over the past decade. The proportion of all hospitalizations involving this infection has climbed. Resistant GN bacteria are becoming more prevalent and are implicated in an increasing proportion of UTIs among hospitalized patients.DESIGN: Survey.METHODS: We first derived the total number of UTI hospitalizations in the United States from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database years 2000-2009. Based on a literature review, we then determined what proportion of all UTIs arise due to each of the organisms of interest, irrespective of resistance pattern. Finally, we assessed the prevalence of resistance within each pathogen based on the Eurofins Surveillance Network database 2000-2009. Susceptibility patterns served as phenotypic surrogates for resistance.OBJECTIVE: Urinary tract infections (UTIs) are common among hospitalized patients. Selection of an appropriate antibiotic for this infection requires knowledge of both its general microbiology and the epidemiology of drug-resistant organisms. We sought to determine secular trends in UTI hospitalizations that involve gram-negative (GN) multidrug-resistant Pseudomonas aeruginosa (MDR-PA), extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae (KP), and carbapenem-resistant Enterobacteriaceae (CRE).PATIENTS: Patients with UTI in US hospitals between 2000 and 2009.RESULTS: Between 2000 and 2009, the frequency of UTI hospitalizations increased by approximately 50%, from 53 to 77 cases per 1,000 hospitalizations. Infections due to all GN bacteria followed a similar trajectory, whereas those caused by resistant GN pathogens increased by approximately 50% (MDR-PA) to approximately 300% (ESBL). CRE emerged and reached 0.5 cases per 1,000 hospitalizations in this 10-year period.All authors: Shorr AF, Zilberberg MDFiscal year: FY2014Digital Object Identifier:

http://dx.doi.org/10.1086/671740

Date added to catalog: 2014-04-04

Holdings ( 1 )
Title notes ( 8 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	23917908	Available		23917908

Available online from MWHC library: 1999 - present, Available in print through MWHC library: 1999 - 2006

CONCLUSIONS: The epidemiology and microbiology of GN UTI hospitalizations has shifted over the past decade. The proportion of all hospitalizations involving this infection has climbed. Resistant GN bacteria are becoming more prevalent and are implicated in an increasing proportion of UTIs among hospitalized patients.

DESIGN: Survey.

METHODS: We first derived the total number of UTI hospitalizations in the United States from the Healthcare Cost and Utilization Project Nationwide Inpatient Sample database years 2000-2009. Based on a literature review, we then determined what proportion of all UTIs arise due to each of the organisms of interest, irrespective of resistance pattern. Finally, we assessed the prevalence of resistance within each pathogen based on the Eurofins Surveillance Network database 2000-2009. Susceptibility patterns served as phenotypic surrogates for resistance.

OBJECTIVE: Urinary tract infections (UTIs) are common among hospitalized patients. Selection of an appropriate antibiotic for this infection requires knowledge of both its general microbiology and the epidemiology of drug-resistant organisms. We sought to determine secular trends in UTI hospitalizations that involve gram-negative (GN) multidrug-resistant Pseudomonas aeruginosa (MDR-PA), extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (EC) and Klebsiella pneumoniae (KP), and carbapenem-resistant Enterobacteriaceae (CRE).

PATIENTS: Patients with UTI in US hospitals between 2000 and 2009.

RESULTS: Between 2000 and 2009, the frequency of UTI hospitalizations increased by approximately 50%, from 53 to 77 cases per 1,000 hospitalizations. Infections due to all GN bacteria followed a similar trajectory, whereas those caused by resistant GN pathogens increased by approximately 50% (MDR-PA) to approximately 300% (ESBL). CRE emerged and reached 0.5 cases per 1,000 hospitalizations in this 10-year period.

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