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  • FLORIDA: A Summary of Select Antimicrobial Resistance Data

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

    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 Florida Department of Health, in response to health care professionals’ concerns about MRSA skin and soft tissue infections, analyzed S. aureus laboratory data from 2003 – 2005.  Private laboratory reports on over 61,000 patients, almost exclusively from outpatient facilities, were analyzed.  The data demonstrate that the number of S. aureus isolates from skin and soft tissue increased more than four times, from 6,216 in 2003 to 29,678 in 2005.  The percentage of MRSA increased from 37.4% of S. aureus isolates from skin and soft tissue in 2003 to 45.6% in 2004 and to 52.6% of isolates in 2005.4 
    • The western panhandle of Florida had the highest percentage of MRSA isolates while the southwestern part of the state had the lowest.  MRSA increased in all age groups and was highest in the 21-30 age group.5 

    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.”6 
    • Noteworthy, these organisms are difficult to detect with the automated testing systems currently used in most hospital laboratories.7 
    • 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.
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    Other antimicrobial resistance issues:

    • The Florida Antimicrobial Resistance Management program grouped Florida hospitals into regions and selected significant organisms to determine resistance rates to common antibiotics over the period 1997-20038:
      • Escherichia coli (E. coli) resistance increased to all antibiotics analyzed, with the greatest increase seen for ciprofloxacin (4% to 22%) in the southern part of the state.
      • S. aureus resistance increased to all antibiotics except vancomycin.
      • For Pseudomonas aeruginosa, increases in resistance were observed for all antibiotics, with the largest increases seen for ciprofloxacin in the northern (28% to 43%) and central (23% to 33%) areas of the state.
      • Enterococcus faecium resistance to vancomycin increased substantially, with the greatest increases occurring in the northern (12% to 77%) and southern (17% to 66%) parts of the state.
       

    Clostridium difficile 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. difficile 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. difficile have increased steadily in Florida over the past few years.  There were 46 in 2000, 99 in 2001, 238 in 2002, 313 in 2003, 430 in 2004, and 477 in 2005.9  
    • There were 24,412 hospital discharges in 2006 in Florida that included C. diff as a diagnosis, according to the Agency for Healthcare Research and Quality (AHRQ).  The cost per C. difficile patient in a hospital is estimated by CDC to be at least $3,500, making the annual healthcare cost for C. difficile in Florida more than $85.4 million.10  

    Public health laboratory capacity:

    A key factor in Florida’s ability to detect, monitor, and control antimicrobial resistance is its public health laboratory capacity.  There has been limited funding in the past for antibiotic resistance education programs and surveillance, and even this limited funding is declining.  Approximately only half of state public health labs can provide some basic resistance testing.  Like many states, Florida 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 Roger Sanderson, regional epidemiologist, Florida Department of Health, “Surveillance of MRSA in the Outpatient Setting in Florida 2003-2005,” Florida’s Antimicrobial Resistance Report 2006.
    5 ibid
    6 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
    7 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
    8 John Gums, Professor of Pharmacy, University of Florida, “Variations in antimicrobial resistance within the State of Florida: Results of the Antimicrobial Resistance Management program,” Florida’s Antimicrobial Resistance Report 2006.
    9 CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown
    10 Healthcare Cost and Utilization Project (HCUP) State Inpatient Databases (SID), Agency for Healthcare Research and Quality, http://www.hcupnet.ahrq.gov/, cited in a July 28, 2008 communication from CDC to Senator Sherrod Brown

     

     

 

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