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NHSN Annual Update:
Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections

Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007

Antimicrobial-resistant pathogens that cause healthcare-associated infections (HAIs) pose an ongoing and increasing challenge to hospitals, both in the clinical treatment of patients and in the prevention of the cross-transmission of these problematic pathogens.  Describing the magnitude of the problem with respect to these antimicrobial-resistant pathogens is challenging, because the levels of antimicrobial resistance vary for different types of healthcare facilities and for different geographic areas, and some resistance phenotypes are difficult for laboratories to detect. However, the findings from such attempts may help the infection control and public health communities target problems and utilize resources more efficiently.

In the News

Featured in The Times
"Ireland 'losing war' on superbug" February 15, 2009
Challenges of Implementing National Guidelines for the Control and Prevention of Methicillin‐Resistant Staphylococcus aureus Colonization or Infection in Acute Care Hospitals in the Republic of Ireland
Fidelma Fitzpatrick, MD; Fiona Roche, PhD; Robert Cunney, MB; Hilary Humphreys, MD; Strategy for the Control of Antimicrobial Resistance in Ireland Infection Control Subcommittee
The research, published in Infection Control and Hospital Epidemiology, found one third of hospitals did not have a written policy on antibiotic use, and only 35% had an antibiotic stewardship programme.

November 2007

Volume 28, Number 11
Infect Control Hosp Epidemiol 2007;28:1255–1260
© 2007 by The Society for Healthcare Epidemiology of America. All rights reserved.
0899-823X/2007/2811-0007$15.00
DOI: 10.1086/522678
Original Article

Epidemiology of Multidrug‐Resistant Bacteria in Patients With Long Hospital Stays

Cagri Buke, MD;

Laurence Armand‐Lefevre, PharmD;

Isabelle Lolom, RT;

Waafa Guerinot, RT;

Claude Deblangy, RN;

Raymond Ruimy, MD, PhD;

Antoine Andremont, MD, PhD;

Jean‐Christophe Lucet, MD, PhD

From the Infection Control Unit (C.B., I.L., W.G., C.D., J.‐C.L.) and the Bacteriology Laboratory (L.A.‐L., R.R., A.A.), Bichat‐Claude Bernard Teaching Hospital, Assistance Publique—Hôpitaux de Paris, and Paris VII Denis Diderot University, Paris, France. (Present affiliation: Ege University Faculty of Medicine, Izmir, Turkey [C.B.].)

Objective.To determine rates of colonization with multidrug‐resistant (MDR) bacteria (ie, methicillin‐resistant Staphylococcus aureus [MRSA], vancomycin‐resistant Enterococcus [VRE], extended‐spectrum β‐lactamase [ESBL]‐producing Enterobacteriaceae, and Acinetobacter baumannii) after prolonged hospitalization and to assess the yield of surveillance cultures and variables associated with colonization with MDR bacteria.

Design.Prospective observational cohort study conducted from February 6 to May 26, 2006.

Methods.All patients who spent more than 30 days in our university hospital (Paris, France) were included. Rectal and nasal swab samples obtained during day 30 screening were examined for MRSA, VRE, ESBL‐producing Enterobacteriaceae, and A. baumannii.

Results.Of 470 eligible patients, 439 had surveillance culture samples available for analysis, including 51 patients (11.6%) with a history of colonization or infection due to 1 or more types of MDR bacteria (MRSA, recovered from 35 patients; ESBL‐producing Enterobacteriaceae, from 16 patients; A. baumannii, from 6 patients; and VRE, from 0 patients) and 37 patients (9.5% of the 388 patients not known to have any of the 4 MDR bacteria before day 30 screening) newly identified as colonized by 1 or more MDR bacteria (MRSA, recovered from 20 patients; ESBL‐producing Enterobacteriaceae, from 16 patients; A. baumannii, from 1 patient; and VRE, from 0 patients). A total of 87 (19.8%) of 439 patients were identified as colonized or infected with MDR bacteria at day 30. Factors that differed between patients with and without MRSA colonization included age, McCabe score, comorbidity score, receipt of surgery, and receipt of fluoroquinolone treatment. Patients with ESBL‐producing Enterobacteriaceae colonization were younger than patients with MRSA colonization.

Conclusions.Differences in the variables associated with MRSA colonization and ESBL‐producing Enterobacteriaceae colonization suggest differences in the epidemiology of these 2 organisms. Day 30 screening resulted in a 72.5% increase in the number of patients identified as colonized with at least 1 type of MDR bacteria.

Received April 11, 2007; accepted July 23, 2007; electronically published September 28, 2007.

Address reprint requests to Jean‐Christophe Lucet, MD, PhD, Unité d’Hygiène et de Lutte contre l’Infection Nosocomiale, GH Bichat‐Claude Bernard, 75877 Paris Cedex 18, France ().

Cited by

Reuven Friedmann, MD; David Raveh, MD; Esther Zartzer, MD; Bernard Rudensky, PhD; Ellen Broide, BSc; Denise Attias, BSc; Amos M. Yinnon, MD. (2009) Prospective Evaluation of Colonization with Extended‐Spectrum β‐Lactamase (ESBL)–Producing Enterobacteriaceae Among Patients at Hospital Admission and of Subsequent Colonization with ESBL‐Producing Enterobacteriaceae Among Patients During Hospitalization •. Infection Control and Hospital Epidemiology 30:6, 534-542
Online publication date: 1-Jun-2009.
Abstract-Full Text-PDF Version (216 kB)
Oguz Resat Sipahi. (2008) Economics of antibiotic resistance. Expert Review of Anti-infective Therapy 6:4, 523-539
Online publication date: 1-Sep-2008.
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