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  • VIRGINIA: A Summary of Select Antimicrobial Resistance Data

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

    Drug-resistant Staphylococcus aureus:

    • Although primarily affecting ill people in hospitals, Methicillin-resistant Staphylococcus aureus (MRSA), a drug-resistant bacterium, infects a growing number of people in the community, including healthy adults and children.  A recent study in the Journal of the American Medical Association demonstrates that MRSA infects more than 94,000 people and kills nearly 19,000 annually in the United States.2
    • Hospitalizations and complications due to MRSA cost nearly double that for non-MRSA stays – $14,000 compared with $7,600 for non-MRSA hospitalizations.  The average length of stay in the hospital for a patient with MRSA infection has been reported to be more than double that for non-MRSA stays – 10.0 days versus 4.6 days.3 
    • MRSA became a reportable condition in Virginia in October 2007.  Between January and June 2009, 458 reported cases of invasive MRSA infection were reported to the Department of Health.4 

    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.”5
    • Noteworthy, these organisms are difficult to detect with the automated testing systems currently used in most hospital laboratories.6
    • 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 causing 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.  C. diff is a common cause of antibiotic-associated diarrhea, accounting for 15-25% of all episodes.  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 of infection, 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 increased steadily in Virginia over the past few years.  There were 23 in 2001, 39 in 2002, 44 in 2003, 71 in 2004, and 114 in 2005.7 
    • Five cases of multidrug resistant tuberculosis (MDR-TB) were reported in Virginia in 2006, compared to three in 2005.8 

    Public health laboratory capacity:

    A key factor in Virginia’s ability to detect, monitor and control antimicrobial resistance is its public health laboratory capacity.  There has been limited to no funding in the past for antibiotic resistance education programs, surveillance, and laboratory testing, and the limited funding that has been available continues to decrease.  Approximately half of state public health laboratories provide some level of basic antimicrobial resistance testing.  Like many states, Virginia lacks the funding and resources to provide the level of laboratory testing support needed to detect and track emerging resistance patterns promptly in a range of pathogens.

    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 Virginia Monthly Morbidity Surveillance Report – Cumulative Data, Virginia Department of Health, July 2009
    5 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
    6 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
    7 CDC Wonder Death Certificate Data, cited in a July 28, 2008 communication to Senator Sherrod Brown
    8 Virginia Epidemiology Bulletin, Vol. 107, No. 6, June 200


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