Trying to get a literal picture of the prevalence and geographic distribution of antibiotic-resistant bacteria in the U.S., the CDC has created an electronic, interactive map that can be accessed on the Web or through a mobile app. The Antibiotic Resistance Patient Safety Atlas reports the percentage of various healthcare-associated infections caused by antibiotic-resistant bacteria. (The atlas can be found at: 1.usa.gov/1SmXtfK.)
“It uses data reported from more than 4,000 healthcare facilities to give national, regional, and state map views of superbug-drug combinations showing percent resistance over time,” CDC Director Tom Frieden, MD, MPH, said at a recent press conference.
The data were reported as HAIs to the CDC’s National Healthcare Safety Network (NHSN) from 2011-2014 by 4,403 healthcare facilities, including general acute care hospitals (3,676), long-term acute care hospitals (506), and free-standing inpatient rehabilitation hospitals (221). Long-term care and skilled nursing facilities were not included at this time due to insufficient available data.
The summary metrics produced by this atlas only reflect HAIs reported to NHSN and are not adjusted to produce national estimates of antibiotic resistance. The CDC also includes a caveat about comparing the percentage of resistance across states, noting that HAI reporting requirements vary by state and the data are not adjusted for patient-level factors like demographics or severity of illness.
Some highlights from the atlas include the following:
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The percent of Enterobacteriaceae resistant to carbapenems (CRE) causing HAIs among states ranged from 0–27.9% (3.5% nationally), with higher percent resistance in several Northeast states and sporadically across the country.
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The percent of Staphylococcus aureus resistant to methicillin (MRSA) causing HAIs among states ranged from 32.5–67.8% (46.4% nationally), with higher percent resistance reported among Southeastern states.
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The percent of P. aeruginosa resistant to antibiotics in at least three categories (multidrug-resistant P. aeruginosa) causing HAIs among states ranged from 3.1–46.9% (14.2% nationally), with higher percent resistance reported among several Southeastern states and sporadically across the country.
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The percent of Acinetobacter resistant to antibiotics in at least three categories (multidrug-resistant Acinetobacter) causing HAIs among states ranged from 5.0–88.1% (54.8% nationally), with highly variable reporting of this less common pathogen across the country.
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The percent of Enterobacteriaceae resistant to extended-spectrum cephalosporins (indicative of extended-spectrum ß– lactamase presence) causing HAIs among states varied by organism:
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E. coli: 0–24.4% (13.4% nationally), with higher percent resistance reported among some Northeastern and Western states, and territories.
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Klebsiella spp.: 0–73.0% (20.0% nationally), with higher percent resistance reported among some Northeastern and Western states, and territories.
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Enterobacter spp.: 15.0–43.2% (28.5% nationally), with less variability reported across states comparted to other ESBL pathogens.
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The percentage of Vancomycin-resistant Enterococcus spp. [VRE]) causing HAIs in states varied by species:
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E. faecium: 38.5–86.5% (77.3% nationally), with high resistance prevalence reported among most states.
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E. faecalis: 0–17.8% (6.9% nationally), with higher resistance prevalence reported among some Midwestern, Northeastern, Mid-Atlantic, and Western states.
Additional pathogens included in the atlas that may be of interest to healthcare professionals include the following:
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The percent of Staphylococcus aureus resistant to methicillin (MRSA) and additional antibiotics suggesting origin in the community (community-associated MRSA) causing HAIs among states ranged from 10.0–55.5% (31.2% national resistance), with higher prevalence reported in some Southern states.
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The percent of E. coli resistant to fluoroquinolone (a commonly prescribed class of antibiotics for infections thought to be caused by E. coli and related organisms) causing HAIs among states ranged from 12.1–50.5% (33.0% national resistance), with higher percent resistance reported in many Southern states, some Western states, and territories.
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The percent of P. aeruginosa resistant to piperacillin/tazobactam causing HAIs among states ranged from 0–41.7% among states (10.0% national resistance), with higher prevalence reported in several Southern states and sporadically across the country.
