This was a retrospective cross-sectional study of antimicrobial susceptibility of all nonduplicate (first isolate in 30 days) Enterobacteriaceae, P. aeruginosa, and Acinetobacter spp. isolates from ICU and non-ICU patients collected from January 1, 2017, to December 31, 2017. Reporting institutions comprised 358 US hospitals included in the BD Insights Research Database (Becton, Dickinson and Company, Franklin Lakes, NJ). The electronic surveillance system and clinical research database (formerly the CareFusion Clinical Research Database) have been previously described [8–10 (link)]. This database provides good geographical representation across the United States and includes both small and large hospitals in urban and rural areas.
The analyses reported here include all nonduplicate Enterobacteriaceae, P. aeruginosa, and Acinetobacter spp. (A. baumannii and A. haemolyticus) isolates from blood, respiratory, urine, skin/wound, intraabdominal, and other sources. Isolates from each source were considered separately; for example, if the patient had a blood and respiratory isolate for P. aeruginosa within 30 days, then an isolate was counted for each source. Isolates from the same patient within 30 days were included if they had different drug susceptibilities (>1 susceptibility difference). Isolates were classified as Carb-NS based on facility reports of intermediate susceptibility or resistance to at least 1 of the following agents: (a) ertapenem, imipenem, meropenem, or doripenem for Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Enterobacter cloacae, Serratia marcescens, and Citrobacter freundii; (b) ertapenem, meropenem, or doripenem for Proteus mirabilis and Morganella morganii; and (c) imipenem, meropenem, or doripenem for P. aeruginosa and Acinetobacter spp.
Care settings were classified using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network classification and further classified as ICU (critical care) and non-ICU (inpatient adult wards, specialty care areas, and step-down wards). Hospital-onset isolates were defined as those occurring >3 days after inpatient admission or within 14 days of previous discharge, whereas admission isolates were defined as those occurring ≤3 days of inpatient admission with no previous admission within the past 14 days. Admission period isolates were classified as ICU-associated if the isolate was collected in the admission period and the patient was admitted to an ICU within 3 days of inpatient admission, and they were classified as non-ICU-associated if the isolate was collected in the admission period and the patient was admitted to a non-ICU location within 3 days of inpatient admission and did not have an ICU admission within 3 days of the inpatient admission. Hospital-onset isolates were classified as ICU-associated if the patient was admitted to an ICU on the specimen collection date and as non-ICU-associated if the patient was admitted to a non-ICU location on the specimen collection date with no ICU admission on that date. The study was approved by the New England Institutional Review Board (Wellesley, MA).
The analyses reported here include all nonduplicate Enterobacteriaceae, P. aeruginosa, and Acinetobacter spp. (A. baumannii and A. haemolyticus) isolates from blood, respiratory, urine, skin/wound, intraabdominal, and other sources. Isolates from each source were considered separately; for example, if the patient had a blood and respiratory isolate for P. aeruginosa within 30 days, then an isolate was counted for each source. Isolates from the same patient within 30 days were included if they had different drug susceptibilities (>1 susceptibility difference). Isolates were classified as Carb-NS based on facility reports of intermediate susceptibility or resistance to at least 1 of the following agents: (a) ertapenem, imipenem, meropenem, or doripenem for Escherichia coli, Klebsiella pneumoniae, Enterobacter aerogenes, Enterobacter cloacae, Serratia marcescens, and Citrobacter freundii; (b) ertapenem, meropenem, or doripenem for Proteus mirabilis and Morganella morganii; and (c) imipenem, meropenem, or doripenem for P. aeruginosa and Acinetobacter spp.
Care settings were classified using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network classification and further classified as ICU (critical care) and non-ICU (inpatient adult wards, specialty care areas, and step-down wards). Hospital-onset isolates were defined as those occurring >3 days after inpatient admission or within 14 days of previous discharge, whereas admission isolates were defined as those occurring ≤3 days of inpatient admission with no previous admission within the past 14 days. Admission period isolates were classified as ICU-associated if the isolate was collected in the admission period and the patient was admitted to an ICU within 3 days of inpatient admission, and they were classified as non-ICU-associated if the isolate was collected in the admission period and the patient was admitted to a non-ICU location within 3 days of inpatient admission and did not have an ICU admission within 3 days of the inpatient admission. Hospital-onset isolates were classified as ICU-associated if the patient was admitted to an ICU on the specimen collection date and as non-ICU-associated if the patient was admitted to a non-ICU location on the specimen collection date with no ICU admission on that date. The study was approved by the New England Institutional Review Board (Wellesley, MA).
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