Resistance to Carbapenem Antibiotics Doubled in Intensive Care Units Interview with:

Eilish McCann, PhD</strong> Director, Outcomes Research (Center for Observational and Real-World Evidence) Merck

Dr. Eilish McCann

Eilish McCann, PhD
Director, Outcomes Research (Center for Observational and Real-World Evidence)
Merck What is the background for this study?

Response: One of the most pressing challenges facing medicine today is the emergence of bacterial resistance to antibiotics. One area of high concern is the increasing prevalence of resistance to powerful antibiotics like carbapenems, as patients with infections due to carbapenem-resistant bacteria have very few alternate effective treatment options.

In this study we used real-world data from a Becton, Dickinson and Company electronic research data set to analyze over 140,000 bacterial isolates from patients at 342 hospitals across the United States, so that we could investigate where the burden of carbapenem resistance is most acute. Importantly analysis of real-world data in this way allows us to gain insights from a large number of hospitals, giving a broad and nationally representative picture of the resistance burden. What are the main findings?

Response: The key finding of this study is that non-susceptibility to carbapenem antibiotics is almost twice as high in bacteria isolated from intensive care units (ICU) than from those isolated from non-ICU treatment settings (9.6% vs. 5.1%, p<0.0001). This suggests that there is a higher likelihood of encountering a carbapenem-resistant bacteria and developing an infection that cannot be treated with carbapenem antibiotics in the ICU. This finding is concerning for patients and hospitals, as patients in the ICU are often sicker and at greater risk of poor outcomes than patients elsewhere in the hospital. Evidence demonstrating where the resistance burden is greatest can help prescribers and health care professionals implement measures to counter the potential for carbapenem resistance effectively, driving improvements in outcomes for patients and healthcare systems. What should readers take away from your report?

Response: This study highlights the importance of understanding the nuanced local ecology of a hospital; for example, high carbapenem antibiotic resistance levels may be identified in a specific treatment setting like the ICU which may not be detectable or fully comprehended when considering data from the entire hospital. Understanding their local environment helps prescribers to tailor antibiotic choices appropriately and to design and implement effective antimicrobial stewardship practices. What recommendations do you have for future research as a result of this study?

Response: One of the key strengths of these real-world data is that in addition to understanding the prevalence of carbapenem non-susceptibility we can also explore the clinical and cost outcomes of the infections caused by resistant bacteria. Ongoing and future work will help us to understand how these outcomes differ between pathogens and across treatment settings, to determine where the burden for patients and the unmet need is greatest.

MSD’s Center for Observational and Real-World Evidence (CORE) team has performed a review of similar European data sources in collaboration with Oxford PharmaGenesis, which is also being presented at ECCMID 2017 (abstract #371). We are actively seeking to collaborate with additional data owners that will enable us to replicate this research in European countries. Is there anything else you would like to add?

Response: The real-world evidence gathered in this study provides information about bacterial resistance which can be linked to outcomes for patients and healthcare systems. In addition, the study complements – and builds on – the research being conducted through MSD’s long-running, worldwide surveillance study monitoring in vitro susceptibility patterns of clinical Gram-negative bacilli to 12 commonly used antibiotics (SMART [Study for Monitoring Antimicrobial Resistance Trends]). We look forward to presenting further evidence from these studies in the future. Thank you for your contribution to the community.


ECCMID abstract:

Carbapenem non-susceptible Gram-negative pathogens in the ICU and non-ICU settings in US hospitals in 2015-2016: A multicenter study

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Last Updated on October 18, 2017 by Marie Benz MD FAAD