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  • ILLINOIS: A Summary of Select Antimicrobial Resistance Data

    Antibiotic-resistant infections have a significant impact in ILLINOIS: 

    Drug-resistant Staphylococcus aureus:

    • Although primarily affecting ill people in hospitals, Methicillin-resistant Staphylococcus aureus (MRSA), a drug-resistant bacteria, is infecting people in the community, 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 infections 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 
    • Consistent with national data, analysis of Illinois hospital discharge data indicates that the burden of MRSA in Illinois hospitals is substantial and has increased significantly during 2002-2006.  This increase in MRSA is observed in all regions of the state.  These findings parallel numerous published reports from individual hospitals, as well as a recent national survey that identified high prevalence of MRSA in hospitals of all types throughout the United States.4 
    • Although the discharge dataset does not distinguish between community and hospital acquired infections, healthcare-associated infections are likely to account for the majority of MRSA infections among hospitalized patients in Illinois. Recent estimates indicate that 30 percent of all hospitalized patients with MRSA have community-associated infections. Applying this estimate to Illinois data, approximately 2.1 infections/1000 discharges were attributable to community-associated MRSA in 2006.5 

    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.
       

    Other antimicrobial resistance issues:

    • Clostridium difficile (C. diff) accounts for 15-25% of all episodes of antibiotic-associated diarrhea.  CDC estimates that 500,000 cases of C. diff infection occur 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%. C diff infection can be very difficult to treat and recurs in at least 20% of cases.
      • Deaths from C. diff in Illinois have increased steadily in recent years.  There were 45 in 2000, 56 in 2001, 92 in 2002, 129 in 2003, 213 in 2004, and 271 in 2005.8 
       

    Public health laboratory capacity:

    A key factor in Illinois’ ability to detect, monitor and control antimicrobial resistance is its public health laboratory capacity.  Across the nation, rising numbers of cases of antimicrobial resistance are currently challenging the ability of state public health laboratories keep pace.  Despite this, funding available to public health departments for laboratory-based antimicrobial resistance surveillance continues to decrease.

     


    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 MRSA in Illinois: Descriptive Analysis of Hospital Discharge Data 2002-2006.  Illinois Department of Public Health, 2008.
    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
    CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown

     



     

 

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