Medical devices are bigger culprit in antibiotic-resistant infections than surgical procedures: CDC analysis

Dive Brief:

Healthcare-associated infections (HAIs) that are antibiotic-resistant resulted more frequently from use of temporary medical devices than from surgical procedures, according to an analysis of patient data from 5,626 sites reported to the Centers for Disease Control and Prevention's National Healthcare Safety Network from 2015 to 2017.
The report, published in the journal Infection Control & Hospital Epidemiology, examined devices like central lines, ventilators and urinary catheters at acute-care hospitals, long-term acute-care hospitals and inpatient rehabilitation facilities.
Patients with antibiotic-resistant, device-associated HAIs were more likely to have been admitted to the hospital several days prior to contracting an infection and therefore were exposed to the pathogen during their stay. Surgical site infections, on the other hand, are often caused by contamination from the patient's skin flora, the report said.

Dive Insight:

The CDC NHSN study looked at devices with a limited use in patients rather than permanent implants. The analysis covered HAIs from central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated events and surgical site infections.

Antimicrobial resistance was higher for device-associated HAIs than for the same bacteria identified after surgical procedures in all phenotypes analyzed except CRE E. coli. For example, the analysis determined that 48.4% of tested Staphylococcus aureus isolated from device-associated infections were methicillin resistant (MRSA), compared to 41.9% in surgical site infections.

The three most frequently reported pathogens were E. coli at 17.5%, Staphylococcus aureus at 11.8% and Klebsiella at 8.8%.

Among the various types of facilities analyzed in the report, long-term acute-care hospitals, which serve one of the most vulnerable patient populations, had significantly more cases involving antibiotic-resistant bacteria than did general hospital wards and short-stay acute care hospitals.

The report also found that HAIs in adult healthcare facilities are more likely to be antibiotic-resistant than those in pediatric settings. The NHSN tracked antimicrobial-resistant pathogens associated with infections in children in 2,545 facilities during the same 2015-2017 period. It found the most common pathogens in pediatric HAIs were Staphylococcus aureus (15.4%), E. coli (12.3%) and coagulase-negative staphylococci (12.1%).

CDC epidemiologist Lindsey Weiner-Lastinger said in a statement the data "serve as an urgent call for healthcare facilities and public health agencies to intensify their efforts to prevent the emergence and spread of antimicrobial resistance."

Separately, U.S. health regulators have stepped up scrutiny of infections tied to medical devices in recent months with efforts to reduce adverse events linked to duodenoscopes. The devices are used in minimally invasive procedures to diagnose and treat conditions of the pancreas and bile duct, and can transfer infection from one patient to another if not cleaned properly.

Medical device reports to the FDA between Oct. 15, 2018, and March 31, 2019, showed three deaths, 45 patient infections and 159 cases of device contamination tied to inadequate reprocessing of duodenoscopes. In August, FDA issued a safety communication urging the development of new types of duodenoscopes with disposable parts due to the risk of infection from fixed endcap models.

The first duodenoscope with a sterile disposable elevator component, made by Pentax of America, was authorized earlier this month. It followed FDA's clearance in October of GI Scientific's adjunctive device designed to shield the distal end of a duodenoscope, and previous clearances for duodenoscopes with removable endcaps.