TY - JOUR
T1 - Antimicrobial resistance prevalence, rates of hospitalization with septicemia and rates of mortality with sepsis in adults in different US states
AU - Goldstein, Edward
AU - MacFadden, Derek R.
AU - Karaca, Zeynal
AU - Steiner, Claudia A.
AU - Viboud, Cecile
AU - Lipsitch, Marc
N1 - Funding Information:
We would like to thank the HCUP Partner states that voluntarily provide their data to the project, and without whom this research would not be possible (https://www.hcup-us.ahrq.gov/partners.jsp). This study does not necessarily represent the views of the NIH or the US Government. An earlier version of the paper was posted on BioRxiv. This work was supported by Award Number U54GM088558 from the National Institute Of General Medical Sciences (ML, EG), and by the in-house research program of the Division of International Epidemiology and Population Studies, The Fogarty International Center, US National Institutes of Health, funded in part by the Office of Pandemics and Emerging Threats at the United States Department of Health and Human Services (CV). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr. Lipsitch reports grants from NIH/NIGMS, during the conduct of the study; personal fees from Affinivax, personal fees from Merck, grants and personal fees from Pfizer, grants from PATH Vaccine Solutions, outside the submitted work. The other authors report no conflicts of interest. Aggregate hospitalization data were used in our analyses, with no informed consent from participants sought. Competing interests: Dr. Lipsitch reports grants from NIH/NIGMS, during the conduct of the study; personal fees from Affinivax, personal fees from Merck, grants and personal fees from Pfizer, grants from PATH Vaccine Solutions, outside the submitted work. The other authors report no conflicts of interest.
Funding Information:
Dr. Lipsitch reports grants from NIH/NIGMS, during the conduct of the study; personal fees from Affinivax, personal fees from Merck, grants and personal fees from Pfizer, grants from PATH Vaccine Solutions, outside the submitted work. The other authors report no conflicts of interest.
Funding Information:
This work was supported by Award Number U54GM088558 from the National Institute Of General Medical Sciences (ML, EG), and by the in-house research program of the Division of International Epidemiology and Population Studies, The Fogarty International Center, US National Institutes of Health, funded in part by the Office of Pandemics and Emerging Threats at the United States Department of Health and Human Services (CV). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Publisher Copyright:
© 2019 Elsevier Ltd
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - Antibiotic resistance
KW - E. coli
KW - fluoroquinolones
KW - mortality
KW - sepsis
KW - septicemia
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U2 - 10.1016/j.ijantimicag.2019.03.004
DO - 10.1016/j.ijantimicag.2019.03.004
M3 - Article
C2 - 30851403
AN - SCOPUS:85066083611
SN - 0924-8579
VL - 54
SP - 23
EP - 34
JO - International Journal of Antimicrobial Agents
JF - International Journal of Antimicrobial Agents
IS - 1
ER -