Burnham, Jason P

Kollef, Marin H

Olsen, Margaret A

English

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Washington University School of MedicineDigital Commons@BeckerOpen Access Publications2019Re-estimating annual deaths due to multidrug-resistant organism infectionsJason P. BurnhamWashington University School of Medicine in St. LouisMargaret A. OlsenWashington University School of Medicine in St. LouisMarin H. KollefWashington University School of Medicine in St. LouisFollow this and additional works at: https://digitalcommons.wustl.edu/open_access_pubsThis Open Access Publication is brought to you for free and open access by Digital Commons@Becker. It has been accepted for inclusion in OpenAccess Publications by an authorized administrator of Digital Commons@Becker. For more information, please contact engeszer@wustl.edu.Recommended CitationBurnham, Jason P.; Olsen, Margaret A.; and Kollef, Marin H., ,"Re-estimating annual deaths due to multidrug-resistant organisminfections." Infection Control & Hospital Epidemiology.40,1. 112-113. (2019).https://digitalcommons.wustl.edu/open_access_pubs/7373Conflicts of interest. The author reports no conflicts of interest relevant tothis article.References1. Brock-Utne JG, Smith SC, Banaei N, Chang SC, Alejandro-Harper D, JaffeRA. Spiking of intravenous bags does not cause time-dependent microbialcontamination: a preliminary report. Infect Control Hosp Epidemiol2018;39:1029–1030.2. Mirrett S, Hanson KE, Reller LB. Controlled clinical comparison of VersaTREKand BacT/ALERT blood culture systems. J Clin Microbiol 2007;45:299–302.3. United States Pharmacopeial Convention. USP 27, NF 22: The United StatesPharmacopeia, the National Formulary, Supplement 1. United StatesPharmacopeial Convention; 2004:3121–3138.4. Heimdahl A, Hall G, Hedberg M, et al. Detection and quantitation by lysis-filtration of bacteremia after different oral surgical procedures. J ClinMicrobiol 1990;28:2205–2209.5. Limeres Posse J, Alvarez Fernandez M, Fernandez Feijoo J, et al.Intravenous amoxicillin/clavulanate for the prevention of bacteraemiafollowing dental procedures: a randomized clinical trial. J AntimicrobChemother 2016;71:2022–2030.6. Upadhyay A, Jaber BL. We use impure water to make dialysate forhemodialysis. Semin Dial 2016;29:297–299.Re-estimating annual deaths due to multidrug-resistantorganism infectionsJason P. Burnham MD1, Margaret A. Olsen PhD, MPH1 and Marin H. Kollef MD21Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri and 2Division of Pulmonary and Critical Care Medicine,Washington University School of Medicine, St. Louis, MissouriTo the Editor—Multidrug-resistant organisms (MDROs) areresponsible for an increasing number of infections each year.1An oft-cited statistic is that MDRO infections cause> 2 millionillnesses and 23,000 deaths each year in the United States.1However, the true burden of MDRO infections remains uncer-tain due to insufficient national reporting rates and an absence ofICD-10 codes specifically for MDRO infections. Therefore, wesought to provide an updated estimate of deaths due to MDROinfections in the United States. Based on availability of data, weprovide an estimation of mortality from MDROs for theyear 2010.In 2010 in the United States, 2,468,435 deaths were registered,2of which 715,000 (29.0%) were inpatient hospital deaths.3 Using aconservative estimate for deaths due to sepsis,4 34.4% of inpatientdeaths occur among patients with sepsis,5 and the reported rate ofMDR pathogens in sepsis is 28.8%.6 With these parameters,MDRO sepsis could cause 70,837 inpatient deaths each year(Table 1).We have yet to assign infection as a cause of death to the1,753,435 outpatient deaths in 2010. Subtracting deaths that areunlikely to be due to infection (eg, suicides, accidents, andhomicides), we are left with 1,572,624 deaths. After subtractingdeaths due to infections, 1,550,536 deaths remain. If 17%–19%of these 1,550,536 deaths are due to infections (despitenot being indexed as such)7 and 28.8% are due to MDROs,there would be 285,680–316,690 deaths in which infectioncontributed to death, of which 82,276–91,207 deaths were dueto MDROs (Table 1).Summing the lower bounds of our estimates for inpatientand outpatient deaths due to MDRO infections gives us153,113 deaths, a number almost 7-fold higher than thatestimated by the CDC (ie, ~ 23,000).1 Assuming a worst-casescenario and summing the upper limits of our estimate,162,044 deaths in the United States were due to MDROinfections in 2010 (Table 1). This would move MDROinfections to the third highest cause of death in the UnitedStates for 2010. All infections would then supersede theMDRO infections group as the third highest cause of death,2with> 500,000 (Table 1).Our estimates illustrate a need for better surveillance andreporting mechanisms for MDRO infections. With rampant over-use of antibiotics, establishment of MDRO breeding and trans-mission centers (long-term acute-care hospitals and nursingfacilities), and increasing rates of iatrogenic immunosuppression,the population at risk for MDRO infections and the likelihood ofdrug resistance will continue to increase. To address this criticalissue, establishing the burden of MDROs is crucial to guideresearch funding allocation.AcknowledgmentsFinancial support. Dr Kollef’s efforts were supported by the Barnes-Jewish Hospital Foundation. Dr Burnham reports that this publication wasmade possible by the NIH-National Center for Advancing TranslationalSciences (NCATS grant no. UL1 TR002345, subaward KL2 TR002346),Table 1. Estimates of Number of Deaths Due to Infection and Multidrug-Resistant Organisms in the United States in 2010Category Deaths Due to InfectionDeaths Due to Multidrug-Resistant Organism InfectionInpatient 245,960 70,837Outpatient 285,680–316,690 82,276–91,207Total 531,640–562,650 153,113–162,044Cite this article: Burnham JP, et al. (2019). Re-estimating annual deaths due tomultidrug-resistant organism infections. Infection Control & Hospital Epidemiology 2019,40, 112–113. doi: 10.1017/ice.2018.304Author for correspondence: Jason P. Burnham, Division of Infectious Diseases,Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051,St Louis, MO 63110. E-mail: burnham@wustl.edu© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.112 Jason P. Burnham et alcomponents of the National Institutes of Health (NIH), and NIHRoadmap for Medical Research. Its contents are solely the responsibilityof the authors and do not necessarily represent the official view ofNCATS or NIH.Conflicts of interest. All authors report no conflicts of interest relevant tothis article.References1. Centers for Disease Control and Prevention. Antibiotic Resistance Threatsin the United States, 2013. Centers for Disease Control and Prevention,Atlanta, GA: 2013.2. Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. National vitalstatistics reports. CDC NCHS National Vital Statistics System 2013;61:1–117.3. Hall MJ, Levant S, DeFrances CJ. Trends in inpatient hospital deaths:National Hospital Discharge Survey, 2000–2010. NCHS Data Brief2013;118:1–8.4. Hartman ME, Saeed MJ, Powell KN, Olsen MA. The comparativeepidemiology of pediatric severe sepsis. J Intensive Care Med 2017. doi:10.1177/0885066617735783.5. Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patientswith sepsis from 2 independent cohorts. JAMA 2014;312:90–92.6. Gandra S, Trett A, Klein EY, Laxminarayan R. Is antimicrobial resistance abigger problem in tertiary care hospitals than in small community hospitalsin the United States? Clin Infect Dis 2017;65:860–863.7. Govindan S, Shapiro L, Langa KM, Iwashyna TJ. Death certificatesunderestimate infections as proximal causes of death in the United States.PloS One 2014;9:e97714.Affected healthcare workers during outbreaks: A report fromthe German consulting center for infection control (BZH)outbreak registrySebastian Schulz-Stübner Privatdozent Dr. med., Marcus Reska Dr. rer. nat., and Reiner Schaumann PrivatdozentDr. med. habil.Deutsches Beratungszentrum für Hygiene (BZH GmbH), Schnewlinstr. 4, 79098 Freiburg im BreisgauTo the Editor—In 2013, the outbreak registry of the Germanconsulting center for infection control and prevention (DeutschesBeratungszentrum für Hygiene, BZH GmbH, Freiburg, Germany)was instituted as a quality assurance project to analyze outbreaksituations to gain epidemiological data and to generate practicaladvice for the affected institutions. After 5 years, the registry nowcontains data for 96 outbreaks plus final analyses. Here, wefocused on outbreaks affecting healthcare workers (HCWs) aspart of the infected or colonized outbreak cohort.Material and MethodsIn contrast to the German legal definition (German infectionprevention law, Infektionsschutzgesetz), which defines 2 or morecases of infection with a presumed epidemiological link as anoutbreak, our registry only includes “major” outbreaks, which aredefined as 5 or more cases of infection or colonization with anepidemiological link or, in cases of special organisms likemultidrug-resistant organisms (MDROs), highly contagious dis-eases with 2 or more cases or sentinel cases of special interest.1The definition was chosen to limit the analytical effort on com-mon outbreaks (eg, with norovirus) to major events but to includecolonization outbreaks without infections if they required com-prehensive infection control interventions.Data from the outbreak analysis were entered without personalidentifiers in an anonymized database according to EuropeanUnion’s (EU) General Data Protection Regulation (GDPR). Thiswas not human research, and data analysis does not require reviewby our institutional review board. Overall, 94 outbreaks were ana-lyzed regarding information related to involvement of HCWs.ResultsThe 94 screened outbreaks involved 464 people with infectionsand 168 with colonization only. The duration of the outbreakmanagement ranged from 1 day to 185 days; the number ofaffected people ranged from 1 to 66 per outbreak. Figure 1shows the distribution of organisms involved and theirrelation to outbreaks of infections (59%), combined outbreakswith infections and colonizations (20%), and colonizationonly (21%).Overall, 192 HCWs became sick as part of an outbreak: 162had norovirus infections, 22 had influenza infections, 8 hadscabies infections. Furthermore, 2 HCWs were found to becolonized with MRSA in the screenings performed during anoutbreak. No clear epidemiological link was identified betweenMRSA colonization status and the outbreak in 1 case, whereasan HCW was identified as superspreader during an upperrespiratory tract infection in the other. In 5 outbreaks withgram-negative MDROs and 1 VRE outbreak, rectal screening ofstaff was performed without any meaningful results.Cite this article: Schulz-Stübner S, et al. (2019). Affected healthcare workers duringoutbreaks: A report from the German consulting center for infection control (BZH)outbreak registry. Infection Control & Hospital Epidemiology 2019, 40, 113–115. doi:10.1017/ice.2018.274Author for correspondence: Privatdozent Dr. Sebastian Schulz-Stübner, DeutschesBeratungszentrum für Hygiene (BZH GmbH), Schnewlinstr. 4, 79098 Freiburg imBreisgau Germany. E-mail: Schulz-stuebner@bzh-freiburg.de© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.Infection Control & Hospital Epidemiology 113

Re-estimating annual deaths due to multidrug-resistant organism infections

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Re-estimating annual deaths due to multidrug-resistant organism infections

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