National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

Abstract

A B S T R A C TObjectives: To determine antimicrobial nonsusceptibility rates for Enterobacteriaceae and Acinetobacter spp. in US hospitals. Methods: We analyzed antimicrobial susceptibilities of non-duplicate Enterobacteriaceae and Acinetobacter spp. isolates reported in 2017 from 375 US hospitals in the BD Insights Research Database. Logistic and Poisson regression modeling methods were used to estimate proportions of resistant isolates and rates per 1000 hospital admissions. National projections were generated based on raking (weighting) methods. Results: The nationwide proportions of resistant isolates in inpatients were an estimated 12.6%, 6.6%, and 1.2% for Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL), multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes, respectively, and 42.4% and 34.5% for Acinetobacter spp. with MDR and Carb-NS phenotypes. Resistance varied by geographic region and hospital size/type. Estimated nationwide rates per 1000 hospital admissions ranged from a high of 7.1 for ESBL Enterobacteriaceae to a low of 0.3 for Carb-NS Acinetobacter spp. The estimated number of isolates occurring in US inpatients each year was 290,220 ESBL, 173,984 MDR, and 30,274 MDR and 9,991 Carb-NS for Acinetobacter spp. Conclusions: National prevalence estimates suggest high levels of antimicrobial resistance and a substantial number of patients with resistant Enterobacteriaceae and Acinetobacter spp. in US hospitals.

<p>Molecular Mechanisms and Epidemiology of Carbapenem-Resistant <em>Escherichia coli</em> Isolated from Chinese Patients During 2002–2017</p>

“…25 Yet, several surveillance programs have reported a highly increasing carbapenem resistance, making clinical treatment more challenging. 26,27 In the current study, 58 of 5796 E. coli isolates exhibited an increasing carbapenem-resistant rate from 2002 to 2017.…”

Spatial Variability in the Resistance and Resilience of Giant Kelp in Southern and Baja California to a Multiyear Heatwave

“…Because kelp resistance data were continuous proportions (i.e., 0 < y < 1), we used beta regression models with a Cauchy latent variable link function (Ferrari and Cribari-Neto, 2004). We used ordinary least squares (OLS) regression to estimate temperature effects on kelp resilience.…”

“…We analyzed models in R 3.5.3 (R Core Team, 2019), using the package "betareg" (Cribari-Neto and Zeileis, 2010) for beta regression models. We assessed the significance of model predictors for OLS and beta regressions using F-tests and likelihood ratio tests, respectively (Ferrari and Cribari-Neto, 2004). We estimated the explanatory power of OLS models using R 2 and of beta regression models using a pseudo-R 2 metric (the squared correlation between the linear predictor and the link-transformed response; Ferrari and Cribari-Neto, 2004).…”

VNRX-5133 (Taniborbactam), a Broad-Spectrum Inhibitor of Serine- and Metallo-β-Lactamases, Restores Activity of Cefepime in Enterobacterales and Pseudomonas aeruginosa

“…For VIM-2, triplicate reactions (150 l) were initiated by addition of the substrate nitrocefin, which was present at concentrations ranging from 11.5 to 200 M. The reaction mixture contained 141 ng (4.5 pmol) of VIM-2 tested against five concentrations of taniborbactam (5,10,20,40, and 80 nM), and substrate hydrolysis was monitored at 486 nm using a BioTek PowerWave XS2 UV/visible spectrophotometric plate reader. In contrast, for NDM-1, triplicate reactions (300 l) were initiated by addition of the substrate cefotaxime, which was present at concentrations ranging from 13.1 to 150 M. The reaction mixture contained 622.4 ng (24 pmol) of NDM-1 tested against seven concentrations of taniborbactam (6,12,24,48,72,96, and 120 nM), and substrate hydrolysis was monitored at 260 nm. Avibactam and vaborbactam showed no significant inhibition up to 50 M. Nitrocefin was used as the substrate for assays with IMP-1.…”

“…spectrum-␤-lactamase (ESBL)-producing Enterobacterales or carbapenem-resistant Enterobacterales (CRE) and 6,700 cases per year of infections caused by multidrug-resistant P. aeruginosa, resulting in 12,900 deaths annually (5). A 2017 study estimated the resistance burden within U.S. inpatients to be 290,000 ESBL-producing, 170,000 MDR, and 30,000 carbapenem-nonsusceptible Enterobacterales infections per year (6). No new antibiotic classes, particularly those active against the challenging Gram-negative pathogens, have been introduced since the introduction of the fluoroquinolones.…”