Table 16.
Estimated Effect of Incomplete Reporting of Carbapenem and Extended-Spectrum Cephalosporin Susceptibility Results on the Nationala Percentage Nonsusceptibleb (%NS), by Pathogen and Phenotype, 2015–2017
| Pathogen | No. Reported | CRE | ESC-NS | ||||||
|---|---|---|---|---|---|---|---|---|---|
| As Reported to NHSN | With Inferred Susceptibilitiesc |
As Reported to NHSN | With Inferred Susceptibilitiesd |
||||||
| % Tested | % NSb | % Tested | % NSb | % Tested | % NSb | % Tested | % NSb | ||
| Enterobacter spp | 8,205 | 77.4 | 6.2 | 78.1 | 6.1 | … | … | … | … |
| Escherichia coli | 36,610 | 73.8 | 0.7 | 91.5 | 0.5 | 84.3 | 20.5 | 91.4 | 18.9 |
| Selected Klebsiella spp | 19,947 | 74.7 | 6.9 | 91.6 | 5.6 | 84.7 | 21.1 | 86.9 | 20.6 |
| Total | CRE: 64,762 | 74.5 | 3.3 | 89.8 | 2.8 | 84.4 | 20.7 | 89.8 | 19.5 |
| ESC-NS: 56,557 | |||||||||
Note. CRE, carbapenem-resistant Enterobacteriaceae (imipenem, meropenem, doripenem, or ertapenem); ESC-NS, extended-spectrum cephalosporin nonsusceptible (cefepime, cefotaxime, ceftazidime, or ceftriaxone); Selected Klebsiella spp, K. oxytoca and K. pneumoniae.
This table consists of adult device-associated infections from acute-care hospitals: central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and possible ventilator-associated pneumonias (PVAPs). Data from inpatient rehabilitation facilities (IRFs) and long-term acute-care hospitals (LTACHs) were excluded.
CRE data are presented as %R (ie, includes only those pathogens that tested resistant). ESC-NS data are presented as %NS (ie, includes pathogens that tested intermediate or resistant).
If a pathogen was reported as “not tested” to carbapenems, susceptibility was inferred as susceptible (S) if the pathogen was susceptible to at least 2 of the following antimicrobials: ampicillin, ampicillin/sulbactam, amoxicillin/clavulanic acid, piperacillin/tazobactam, cefazolin, cefoxitin, or cefotetan. Inferring susceptibility effectively raises the number of tested isolates (ie, the denominator of %NS).
If a pathogen was reported as “not tested” to ESCs, susceptibility was inferred as susceptible (S) if the pathogen tested susceptible to at least 2 of the following antimicrobials: ampicillin, aztreonam, or cefazolin. Inferring susceptibility effectively raises the number of tested isolates (ie, the denominator of %NS). Due to Enterobacter spp’s inducible resistance to some ESCs, the inferred susceptibility method for ESC-NS was not applied to Enterobacter spp.