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. 2019 Jul;54(1):23-34.
doi: 10.1016/j.ijantimicag.2019.03.004. Epub 2019 Mar 6.

Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states

Edward Goldstein  1 , Derek R MacFadden  2 , Zeynal Karaca  3 , Claudia A Steiner  3 , Cecile Viboud  4 , Marc Lipsitch  5
Affiliations

Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states

Edward Goldstein et al. Int J Antimicrob Agents. 2019 Jul.

Abstract

Objectives: Rates of hospitalization with sepsis/septicemia and associated mortality in the US have risen significantly during the last two decades. Antibiotic resistance may contribute to the rates of sepsis-related outcomes through lack of clearance of bacterial infections following antibiotic treatment during different stages of infection. However, there is limited information about the relationship between prevalence of resistance to various antibiotics in different bacteria and rates of sepsis-related outcomes.

Methods: For different age groups of adults (18-49y, 50-64y, 65-74y, 75-84y, 85+y) and combinations of antibiotics/bacteria, we evaluated associations between state-specific prevalence (percentage) of resistant samples for a given combination of antibiotics/bacteria among catheter-associated urinary tract infections (CAUTIs) in the CDC Antibiotic Resistance Patient Safety Atlas data between 2011-2014, and rates of hospitalization with septicemia (ICD-9 codes 038.xx present on the discharge diagnosis) reported to the Healthcare Cost and Utilization Project (HCUP), as well as rates of mortality with sepsis (ICD-10 codes A40-41.xx present on death certificate).

Results: Among the different combinations of antibiotics/bacteria, prevalence of resistance to fluoroquinolones in Escherichia coli had the strongest association with septicemia hospitalization rates for individuals aged over 50y, and with sepsis mortality rates for individuals aged 18-84y. There were several positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization/sepsis mortality rates in adults.

Conclusions: These findings, and those from work on the relationship between antibiotic use and sepsis rates, support the association between use of/resistance to certain antibiotics and rates of sepsis-related outcomes, indicating the potential utility of antibiotic replacement.

Keywords: Antibiotic resistance; E. coli; fluoroquinolones; mortality; sepsis; septicemia.

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Figures

Figure 1:
Figure 1:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 65+y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 85+y of septicemia hospitalizations (principal or secondary diagnosis) recorded in the HCUP data [22], 2011–12.
Figure 2:
Figure 2:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 65+y in the CDC AR Atlas data [21],2011–14 and state-specific average annual rates per 100,000 individuals aged 75–84y of septicemia hospitalizations (principal or secondary diagnosis) recorded in the HCUP data [22], 2011–12.
Figure 3:
Figure 3:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 65+y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 65–74y of septicemia hospitalizations (principal or secondary diagnosis) recorded in the HCUP data [22], 2011–12.
Figure 4:
Figure 4:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 19–64y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 50–64y of septicemia hospitalizations (principal or secondary diagnosis) recorded in the HCUP data [22], 2011–12.
Figure 5:
Figure 5:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 19–64y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 18–49y of septicemia hospitalizations (principal or secondary diagnosis) recorded in the HCUP data [22], 2011–12.
Figure 6:
Figure 6:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 65+y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 85+y of mortality with sepsis listed on the death certificate, 2013–14 [23].
Figure 7:
Figure 7:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 65+y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 75–84y of mortality with sepsis listed on the death certificate, 2013–14 [23].
Figure 8:
Figure 8:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 65+y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 65–74y of mortality with sepsis listed on the death certificate, 2013–14 [23].
Figure 9:
Figure 9:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 19–64y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 50–64y of mortality with sepsis listed on the death certificate, 2013–14 [23].
Figure 10:
Figure 10:
Correlation between state-specific prevalence (percentages) of resistance for different combinations of antibiotics/bacteria in CAUTI samples from hospitalized individuals aged 19–64y in the CDC AR Atlas data [21], 2011–14 and state-specific average annual rates per 100,000 individuals aged 18–49y of mortality with sepsis listed on the death certificate, 2013–14 [23].
Figure 11:
Figure 11:
State-specific prevalence (proportion) of resistance to fluoroquinolones in E. coli for CAUTI samples in hospitalized individuals aged 65+y in the CDC Antibiotic Resistance Atlas data [21], 2011–14 vs. state-specific average annual rates per 100,000 individuals aged 85+y of septicemia hospitalizations (principal or secondary diagnosis) recorded in the HCUP data [22], 2011–12 for the 42 states reporting septicemia hospitalization data (Methods).
Figure 12:
Figure 12:
State-specific prevalence (proportion) of resistance to fluoroquinolones in E. coli for CAUTI samples in hospitalized individuals aged 65+y in the CDC Antibiotic Resistance Atlas data [21], 2011–14 vs. state-specific average annual rates per 100,000 individuals aged 75–84y of sepsis mortality (underlying or contributing cause of death) recorded in the CDC Wonder data [23], 2013–14 for the 50 states + District of Columbia.
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