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. 2017 Dec 30;58(4):E294-E301.
doi: 10.15167/2421-4248/jpmh2017.58.4.774. eCollection 2017 Dec.

Changes in the incidence and antimicrobial susceptibility of healthcare-associated infections in a New York hospital system, 2006-2012

B Cohen  1   2 , J Liu  1 , E Larson  1   2
Affiliations

Changes in the incidence and antimicrobial susceptibility of healthcare-associated infections in a New York hospital system, 2006-2012

B Cohen et al. J Prev Med Hyg. .

Abstract

Introduction: National efforts to curtail healthcare-associated infections (HAI) proliferated recently, though data detailing progress over time are limited. This retrospective cohort study aims to describe changes in incidence and antimicrobial susceptibility of HAI in four New York City hospitals over seven years.

Methods: Electronic data were collected retrospectively for all patients discharged from 2006 through 2012. Previously validated computerized algorithms based on National Healthcare Safety Network criteria detected bloodstream infections, pneumonia, surgical site infections, and urinary tract infections with Enterococcus spp., Staphylococcus aureus, Streptococcus pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae. Antimicrobial susceptibilities were obtained from electronic laboratory records. Logistic regression was used to assess changes in odds of acquiring an HAI and odds of antimicrobial resistance over time, controlling for age, gender, severity of illness, previous hospitalizations, and admission source.

Results: In total, 19,052 HAI were identified among 761,426 discharges. HAI rates fell for all organisms, all infection types, and within all hospitals. Odds of acquiring an HAI decreased significantly over time for all organisms. Resistance levels were stable for Enterococcus spp., S. aureus, A. baumannii, and S. pneumoniae. Multidrug resistance increased for P. aeruginosa and decreased for K. pneumoniae, though imipenem resistance among K. pneumoniae climbed sharply in 2011.

Conclusions: This study suggests that HAI incidence rates are falling, possibly due to increased federal, state and local attention to healthcare quality and patient safety. Though we found no substantial reductions in resistance, recent national attention towards antimicrobial stewardship may precipitate a change in coming years.

Keywords: Antimicrobial resistance; Bloodstream infections; Multidrug-resistant organisms; Surgical site infections; Urinary tract infections.

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Figures

Fig. 1.
Fig. 1.
Algorithms for identifying four types of infections using electronically available data from laboratory records and International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes. Definitions are based on the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN) guidelines for surveillance of HAIs [7]. ICD-9-CM codes for pneumonia included 003.22, 020.3-020.5, 021.2, 022.1, 031.0, 039.1, 052.1, 055.1, 073.0, 083.0, 112.4, 114.0, 114.4, 114.5, 115.05, 115.15, 115.95, 130.4, 136.3, 480.0-480.3, 480.8, 480.9, 481, 482.0-482.3, 482.30-482.32, 482.39, 482.4, 482.40, 482.41, 482.42, 482.49, 482.8, 482.81-482.84, 482.89, 482.9, 483, 483.0, 483.1, 483.8, 484.1, 484.3, 484.5-484.8, 485, 486, 513.0, and 517.1. CFU/mL, colony forming units per milliliter.
Fig. 2.
Fig. 2.
Annual incidence of healthcare-associated infections per 10,000 admissions in four New York City hospitals, 2006-2012. The percent decrease in infection rate between 2006 and 2012 is displayed for each organism.
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