OBJECTIVES: In the US, antibiotic-resistant (ABR) pathogens infect >2 million people and cause nearly 23,000 deaths annually. In 2013, the Centers for Disease Control and Prevention identified Clostridium difficile (C. diff), carbapenem-resistent Enterobacteriaceae (CRE), and drug-resistant Neisseria gonorrhoeae (N. gonorrhoeae) as the nation’s most urgent ABR threats. To understand the trajectory of ABR infections, we examined annual C. diff-, CRE-, and N. gonorrhoeae-related hospitalization and death rates in the US.
METHODS: Data from the 2001-2012 Healthcare Cost and Utilization Project’s National Inpatient Sample (NIS), nationally representative surveys of US hospitalizations, were analyzed. Overall and age- and gender-stratified annual rates of C. diff-, CRE-, and N. gonorrhoeae-related hospitalizations (per 10,000 people) and deaths per 10,000 hospitalizations were calculated.
RESULTS: C. diff-related hospitalizations increased gradually from 5.2 in 2001 to 11.9 in 2012. CRE-related hospitalizations more than doubled between 2010 (5.6) and 2012 (11.9). N. gonorrhoeae-related hospitalizations remained fairly constant (0.2 in 2001 to 0.1 in 2012). C. diff-related hospitalizations among persons aged 85+ increased substantially, from 55.7 in 2001 to a high of 113.3 in 2008. CRE-related hospitalizations were also highest for the 85+ age group. Females had substantially higher rates than males for all three pathogens over time. Death rates steadily increased for each pathogen during the study period.
CONCLUSIONS: C. diff- and CRE-related hospitalization rates have increased substantially over the past decade, while N. gonorrhoeae-related hospitalization rates remained constant. Both C. diff and CRE are commonly spread in healthcare settings; therefore, rising hospitalization rates with these infections is unsurprising. The recent surge in CRE-related hospitalizations is consistent with other studies that suggest increased use of carbapenems is partly responsible for increasing rates. These findings indicate need for immediate attention to developing interventions to curb the growth of C. diff and CRE infections to reduce the burden on the patient population and healthcare system.
