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  • DELAWARE: A Summary of Select Antimicrobial Resistance Data

    Antibiotic-resistant infections have become significant threats to citizens of DELAWARE:

    Drug-resistant Staphylococcus aureus:

    • Although primarily affecting ill people in hospitals, Methicillin-resistant Staphylococcus aureus (MRSA), a drug-resistant bacteria, are infecting a growing number of people in the community and outside hospitals, including healthy athletes and children.  A recent study in the Journal of the American Medical Association demonstrates that MRSA alone infects more than 94,000 people and kills nearly 19,000 annually in the United States – more deaths than those caused by emphysema, HIV/AIDS, Parkinson’s disease, and homicide.2 
    • Hospitalizations for or complicated by MRSA cost nearly double that for non-MRSA stays – $14,000 for MRSA stays compared with $7,600 for non-MRSA stays.  The average length of stay in the hospital for a patient with MRSA infection was more than double that for non-MRSA stays – 10.0 days versus 4.6 days.3 
    • The number of hospital discharges in Delaware with a secondary diagnosis of MRSA has risen from 20 in 1994 to 874 in 2005.  Additionally, the number of MRSA discharges in Delaware hospitals has more than tripled from 2000 to 2005, with a 64 percent increase from 2004 to 2005.4 
    • MRSA associated hospitalizations in Delaware had longer average stays and higher total charges than non-MRSA hospitalizations. The average length of stay was almost 3 days longer for MRSA hospitalizations. The average charge for MRSA hospitalizations was $21,471 compared to an average of $16,531 for non-MRSA hospitalizations.5 
    • Since MRSA became a mandatory reportable disease for health care providers in 2006, DPH recorded 1,905 cases that year. More than 1,700 cases have occurred thus far in 2007.6  

    Drug-resistant “gram negative” bacterial infections:

    • Serious and life-threatening infections due to antibiotic resistant “gram negative” bacteria are on the rise across the United States.  Gram negative bacteria primarily are differentiated from gram positive bacteria, like MRSA, by a cell wall that is particularly adept at preventing antibiotics from entering the bacteria.  These infections, primarily acquired in hospitals and long term care settings, are extremely difficult to treat and cause significant numbers of illnesses and deaths.  Bacteria in this group include:  Escherichia coli (E. coli), Klebsiella pneumonia, Pseudomonas aeruginosa, and Acinetobacter.
    • In March 2009, CDC published guidelines for detection and control of E. coli and Klebsiella species with increasing resistance to a subclass of antibacterial drugs known as carbapenems.  Carbapenems are among the most potent antibiotics currently available and are often considered the “last line of defense” in the treatment of antibiotic resistant bacteria.  Studies have shown that the mortality rate from infections caused by carbapenem resistant Klebsiella species is roughly 40%.  CDC described this problem as “another in a series of worrisome public health developments regarding antimicrobial resistance among gram-negative bacteria [that] underscores the immediate need for aggressive detection and control strategies.”7 
    • Noteworthy, these organisms are difficult to detect with the automated testing systems currently used in most hospital laboratories.8 
    • Of critical importance, there are few to no approved antibacterial drugs currently available to treat many gram negative bacterial infections and few to no new drugs in the pipeline; drug discovery in this area is extremely difficult due to challenges in overcoming the gram negative bacteria’s cell wall.

    Other antimicrobial resistance issues:

    • Clostridium difficile (C. diff) is spawning infections in hospitals in the U.S. and abroad that can lead to severe diarrhea, ruptured colons, perforated bowels, kidney failure, blood poisoning and death.  It is a common cause of antibiotic-associated diarrhea, accounting for 15-25% of all episodes.  CDC estimates there are 500,000 cases of C. diff infection annually in the U.S., contributing to between 15,000 and 30,000 deaths.  Elderly hospitalized patients are at especially high risk and mortality in these patients may exceed 10%.  The disease is very difficult to treat and recurs in at least 20% of cases, even when treated appropriately.
      • Deaths from C. diff have fluctuated in Delaware over the past few years.  There were 5 in 2001, 15 in 2002, 6 in 2003, 15 in 2004, and 18 in 2005.9 
      • Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a serious and life-threatening multidrug-resistant bacteria that has recently emerged in Delaware.  Klebsiella Pneumoniae Carbapenemase (KPC) is the enzyme found in CRKP that is responsible for conferring resistance to broad-spectrum antibiotics.  CDC is closely monitoring KPC, which is highly resistant to nearly all antimicrobial agents.  The CDC has identified Delaware as one of four states where KPC-containing organisms frequently occur.10 

    Public health laboratory capacity:

    A key factor in Delaware’s ability to detect, monitor and control antimicrobial resistance is its public health laboratory capacity.  Across the nation, increasing cases of antimicrobial resistance are currently swamping the ability of each state's public health laboratory to keep pace.  There has been limited funding in the past for antibiotic resistance education programs and surveillance, and even this limited funding is on the decrease.  Approximately only half of state public health labs can provide some basic resistance testing.  Like many states, Delaware lacks the targeted technical ability to detect and characterize emerging resistance patterns promptly in a range of pathogens. Therefore, such resistant organisms continue to spread unrecognized and unimpeded throughout the state.


    1 Dr. Fred Tenover, quoted in “The Bacteria Fight Back” Science, July 18, 2008. 
    2 R. Monina Klevens et al. “Invasive Methicillin-resistant Staphylococcus aureus Infections in the United States,” JAMA, October 17, 2007: 1763-1771.
    3 Elixhauser, A. and Steiner, C. Infections with Methicillin-Resistant Staphylococcus aureus (MRSA) in U.S. Hospitals, 1993–2005. HCUP Statistical Brief #35. July 2007. Agency for Healthcare Research and Quality.
    4 Methicillin-Resistant Staphylococcus aureus (MRSA) Associated Hospitalizations in Delaware, Delaware Health Statistics Center StatSheet, Delaware Department of Health and Social Services, November 30, 2007
    5 ibid
    6 Delaware Department of Health and Social Services press release, November 1, 2007
    7 CDC MMWR “Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities” March 20, 2009 / Vol. 58 / No. 10
    8 K. F. Anderson, et al.; Evaluation of Methods To Identify the Klebsiella pneumoniae Carbapenemase in Enterobacteriaceae; Journal of Clinical Microbiology, August 2007, p. 2723-2725, Vol. 45, No. 8
    9 CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown
    10 CDC data cited in a July 28, 2008 communication to Senator Sherrod Brown



     

 

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