Epidemiology of Opportunistic Premise Plumbing Pathogens and Associated Antibiotic Resistance 公开
Roth, David Milton (2017)
Published
Abstract
Purpose: Opportunistic Premise Plumbing Pathogens (OPPPs) are naturally occurring organisms that are commonly found within premise plumbing. The most commonly thought of OPPPs are the nontuberculous mycobacteria (NTM) and bacteria Legionella and Pseudomonas. Previous research has estimated that up to 30% of the U.S. population may be exposed to OPPPs. The primary objective of this analysis was to provide national and regional epidemiologic estimates for the commonly thought of OPPPs. The secondary objective was to explore predictive factors associated with antibiotic resistance in individuals hospitalized with an OPPP.
Methods: We used the 2012 Healthcare Cost and Utilization Project National Inpatient Sample for this study. Estimates of demographics, hospitalization characteristics, comorbidities, antibiotic resistance and associated costs for all three selected OPPPs were calculated using SAS survey procedures. Logistic regression techniques were used to create a parsimonious predictive model of antibiotic resistance among hospitalizations involving Pseudomonas pneumonia.
Results: In 2012, there were an estimated 73,565 discharges of non-institutionalized U.S. patients with an infection due to an OPPP, with 610 hospitalizations involving multiple OPPPs. Pseudomonas showed no variability across season or region. Legionnaires' Disease showed a distinct seasonal trend peaking in Summer/Fall. Higher relative percentage of hospitalizations were observed for NTMs in the Southeast and for Legionnaires' Disease in the Northeast/Mid-Atlantic. Antibiotic resistance was recorded in an estimated 2.2% of all hospitalizations, with the median charge of hospitalization involving an OPPP and no antibiotic resistance being $63,654. Antibiotic resistance increased the mean charge by 14%. In a backwards-eliminated predictive model of antibiotic resistance among hospitalizations involving Pseudomonas pneumonia, association (OR; 95%CI) was seen in age over 65 (1.20; 0.93, 1.55), female gender (1.57; 1.13, 2.17), and urinary catheterization among those aged 65+ (3.29; 1.37, 7.86). Inverse association was seen in receiving intubation (0.59; 0.41, 0.85) and being female with a chronic lung condition (0.69; 0.49, 0.97).
Conclusion: This analysis shows that individuals of all ages are at risk of an OPPP infection. In addition, the HCUP data was shown to correlate very highly with the results of the CDC Legionnaires' Disease surveillance systems confirming seasonal and regional variability in a nationally representative sample.
Table of Contents
Introduction.................................................1
Background..................................................3
Methods......................................................6
Data Source.........................................6
Inclusion/Exclusion Criteria......................6
Analyses..............................................7
Results........................................................9
National Estimates.................................9
Antibiotic Resistance Modeling.................13
Discussion...................................................16
Conclusions and Recommendations...................23
References..................................................24
Tables and
Figures........................................28
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