Antimicrobial resistance prevalence and rates of hospitalization with septicemia in the diagnosis in adults in different US states

Background: Rates of hospitalization with sepsis and septicemia in the US have risen significantly during the last two decades, and changes in diagnostic practices do not fully explain that rise. Antibiotic resistance may contribute to the rates of sepsis/septicemia hospitalization through lack of clearance of bacterial infections following antibiotic treatment during different stages of infection. At the same time, there is limited information about the relation between prevalence of resistance to various antibiotics in different bacteria and rates of hospitalizations with sepsis and septicemia. Methods: For different age groups of adults (18-49y, 50-64y, 65-74y, 75-84y, 85+y) and combinations of antibiotics/bacteria, we evaluated associations between state-specific average annual rates of hospitalizations with septicemia (ICD-9 codes 038.xx present on the discharge diagnosis) in a given age group reported to the Healthcare Cost and Utilization Project (HCUP) between 2011-2012, and state-specific prevalence (percentage) of resistant samples for a given combination of antibiotics/bacteria among catheter-associated urinary tract infections in the CDC Antibiotic Resistance Patient Safety Atlas data between 2011-2014. Results: Prevalence of resistance to fluoroquinolones in E. coli had the strongest association with septicemia hospitalization rates for adults aged over 50y. A number of positive correlations between prevalence of resistance for different combinations of antibiotics/bacteria and septicemia hospitalization rates in adults were also found. Conclusions: Our findings about the relation between prevalence of resistance to commonly prescribed antibiotics, particularly fluoroquinolones, and rates of septicemia hospitalization in US adults stress the need for enhancing antibiotic stewardship in different settings, especially for fluoroquinolones, preventing acquisition of antibiotic-resistant bacteria, and new antibiotics.