Antibiotic Resistance Impacted by Patient Age and Care Setting, Study Finds
By Christopher Cheney
To reduce antibiotic resistance, hospitals should use care setting-specific antibiotic stewardship programs that are based on the type of facility and patient age, a recently published research article found.
Antimicrobial resistance occurs when germs such as bacteria and fungi develop the ability to be resistant to the drugs that are designed to kill them, according to the Centers for Disease Control and Prevention (CDC). In the United States, there are more than 2.8 million antimicrobial-resistant infections annually that are associated with more than 35,000 deaths, the CDC says.
The recent research article, which was published by JAC-Antimicrobial Resistance, is based on data collected from 166 facilities from 2012 to 2017. The data was separated into four patient groups: children, adults, children treated at standalone pediatric facilities, and children treated at facilities that serve both children and adults.
The results of the research article include a key finding: resistance rates for antibiotics were associated with age and care setting. For example, ertapenem-resistant Enterobacter cloacae in children increased significantly compared with adults, and ertapenem-resistant Enterobacter cloacae among children in pediatric facilities increased significantly compared to facilities that serve both children and adults.
Interpreting the data
The research article is based on a powerful set of data, a co-author of the study told HealthLeaders. “It’s important to look at this project as using a national dataset. All too often, research involving antibiotic resistance is either a single institution looking within their organization or research that looks at national datasets that do not have this level of detail. So, one of our goals was to evaluate the influence of patient age and care setting on the profile of antibiotic resistance,” said Mark Hoffman, PhD, chief research information officer at Kansas City, Missouri-based Children’s Mercy Hospital.
The researchers found that the results varied depending on the combination of the bacteria and the antibiotic, he said. “In some cases, we found that older patients were more likely to have an antibiotic-resistant bacteria than younger patients. In other cases, we would find that younger patients were more likely to have an antibiotic-resistant version of that bacteria.”
In many cases, there were decreases in antibiotic resistance, which is encouraging because the national efforts in antibiotics stewardship appear to be making a difference, Hoffman said. “We did see in Shigella and Streptococcus, as two examples, evidence that there are increasing patterns of resistance to bacteria-drug combinations. But we also saw several instances where the prevalence of resistant bacteria is apparently dropping.”
The difference in antibiotic resistance between children and adults varies based on the combination of the bacteria and the drug, he said. “We did find some evidence that for some combinations children were more likely to have a resistant version of the bacteria than adults and vice versa for other combinations. Reflecting on the patient context or the patient demographics including their age is underutilized, but we have shown that it is an important factor.”
The impact of the facility category on antibiotic resistance in children varied, Hoffman said. “We know that children treated in standalone pediatric facilities are often more complex; so, to some extent, that can be a reflection on a variety of risk factors that children treated at standalone facilities are challenged with. That can be one factor. Standalone pediatric facilities are also often leaders in antibiotic stewardship; so, in the instances where we saw lower prevalence of resistant bacteria in the pediatric setting, our hope is that reflects our efforts in antibiotics stewardship.”
The study is particularly helpful for emergency department clinicians, he said. “In emergency departments, decisions are made about which antibiotic you start the patient on. Do you start them with Cipro or do you start them with another antibiotic? Having our data in the hands of emergency physicians can help inform that first treatment before they have the culture results. The more information those providers have about patterns, the better decisions they can make in terms of that first treatment decision that is made in the absence of a culture result.”
The study is an example of harnessing data, Hoffman said. “A key factor of our strategy was using national data resources to better understand what is happening locally and what is happening for different categories of patients. At Children’s Mercy Hospital, we are always focused on how we can use data to better treat children, and our study is a step forward in providing more tools for providers as they make important decisions.”
Christopher Cheney is the senior clinical care editor at HealthLeaders.