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Antimicrobial Use and Resistance in Eight US Hospitals: Complexities of Analysis and Modeling

Published online by Cambridge University Press:  02 January 2015

Dominique L. Monnet ,
Lennox K. Archibald ,
Lisa Phillips ,
Fred C. Tenover ,
John E. McGowan Jr ,
Robert P. Gaynes  and
Intensive Care Antimicrobial Resistance Epidemiology Project and the National Nosocomial Infections Surveillance System Hospitals
Dominique L. Monnet
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention and the Epidemiology Dept., Rollins School of Public Health of Emory University, Atlanta, Georgia Statens Serum Institut in Copenhagen, Denmark
Lennox K. Archibald
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention and the Epidemiology Dept., Rollins School of Public Health of Emory University, Atlanta, Georgia
Lisa Phillips
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention and the Epidemiology Dept., Rollins School of Public Health of Emory University, Atlanta, Georgia
Fred C. Tenover
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention and the Epidemiology Dept., Rollins School of Public Health of Emory University, Atlanta, Georgia
John E. McGowan Jr
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention and the Epidemiology Dept., Rollins School of Public Health of Emory University, Atlanta, Georgia
Robert P. Gaynes*
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention and the Epidemiology Dept., Rollins School of Public Health of Emory University, Atlanta, Georgia
*
Hospital Infections Program, Centers for Disease Control and Prevention, Mailstop E-55, 1600 Clifton Rd NE, Atlanta, GA 30333
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Abstract

OBJECTIVE:

To evaluate the relation between antimicrobial use and resistance in intensive-care unit (ICU) and non-ICU inpatient areas in eight US hospitals.

METHODS:

We determined antimicrobial use in terms of defined daily doses, antimicrobial-use density (defined daily doses/1,000 patient days), and percentage resistance for five antimicrobial-organism combinations in the ICU and non-ICU inpatient areas of eight US hospitals participating in project Intensive Care Antimicrobial Resistance Epidemiology.

RESULTS:

Antimicrobial resistance and use varied tremendously among the eight hospitals. Antimicrobial resistance among these five nosocomial pathogens was significantly higher within the inpatient setting of these hospitals, compared with the outpatient setting. One hospital consistently ranked highest for use of all classes of antimicrobials examined. High antimicrobial use was not associated necessarily with high resistance for a particular antimicrobial-organism pair.

CONCLUSION:

Antimicrobial use varied significantly across these hospitals, but generally was higher in ICUs. These results suggest that concomitant surveillance of both antimicrobial resistance and antimicrobial use is helpful in interpreting antimicrobial resistance in a hospital or ICU and that further analysis is required to determine the role of variables other than antimicrobial use in a statistical model for predicting antimicrobial resistance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 6 , June 1998 , pp. 388 - 394
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

1. Office of Technology Assessment. Impacts of Antibiotic-Resistant Bacteria. Washington, DC: US Congress; 1995. US Government Printing Office, OTA-H-629.Google Scholar
2. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
3. Flaherty, JP, Weinstein, RA. Nosocomial infection caused by antibiotic-resistant organisms in the intensive-care unit. Infect Control Hosp Epidemiol 1996;17:236–248.CrossRefGoogle ScholarPubMed
4. Voss, A, Milatovic, D, Wallrauch-Schwartz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50–55.CrossRefGoogle ScholarPubMed
5. Panlilio, AL, Culver, DH, Gaynes, RP, Banerjee, S, Henderson, T, Tolson, JS, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582–586.Google ScholarPubMed
6. Burwen, DR, Banerjee, SN, Gaynes, RP, the National Nosocomial Infections Surveillance System. Ceftazidime resistance among selected nosocomial gram-negative bacilli in the United States. J Infect Dis 1994;170:1622–1625.Google Scholar
7. Coronado, VG, Edwards, JR, Culver, DH, Gaynes, RP, the National Nosocomial Infections Surveillance System. Ciprofloxacin resistance among nosocomial Pseudomonas aeruginosa and Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1995;16:71–75.Google Scholar
8. Gaynes, RP, Culver, DH, the National Nosocomial Infections Surveillance System. Resistance to imipenem among selected gram-negative bacilli in the United States. Infect Control Hosp Epidemiol 1992;13:10–14.Google Scholar
9. McGowan, JE Jr, Hall, EC, Parrott, PL. Antimicrobial susceptibility in gram-negative bacteremia: are nosocomial isolates really more resistant? Antimicrob Agents Chemother 1989;33:1855–1859.Google Scholar
10. Bryce, EA, Smith, JA. Focused microbiological surveillance and gramnegative beta-lactamase-mediated resistance in an intensive-care unit. Infect Control Hosp Epidemiol 1995;16:331–334.Google Scholar
11. Jarvis, WR, Edwards, JR, Culver, DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(suppl 3B):185S–191S.Google Scholar
12. Yu, VL, Oakes, CA, Axnick, KJ, Merigan, TC. Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens . Am J Med 1979;44:468–473.Google Scholar
13. Gaynes, R. Antibiotic resistance in ICUs: a multifaceted problem requiring a multifaceted solution. Infect Control Hosp Epidemiol 1995;16:328–330.Google Scholar
14. Shlaes, DM, Gerding, DN, John, JF Jr, Craig, WA, Bornstein, DL, Duncan, RA, et al. Society for Healthcare Epidemiology and Infectious Diseases Society of America Joint Committee on the Prevention of Antimicrobial Resistance: guidelines for the prevention of antimicrobial resistance in hospitals. Infect Control Hosp Epidemiol 1997;18:275–291.Google Scholar
15. McGowan, JE Jr. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis 1983;5:1033–1048.CrossRefGoogle ScholarPubMed
16. O'Brien, T. The global epidemic nature of antimicrobial resistance and the need to monitor and manage it locally. Clin Infect Dis 1997;24(suppl 1):S2–S8.CrossRefGoogle ScholarPubMed
17. Monnet, DL, Biddle, JW, Edwards, JR, Culver, DH, Tolson, JS, Martone, WJ, et al. Extended spectrum beta-lactam-resistant nosocomial Klebsiella pneumoniae: epidemiologic evidence of interhospital transmission. Infect Control Hosp Epidemiol 1994;15:17. Abstract 24.Google Scholar
18. McGowan, JE Jr, Tenover, FC. Control of antimicrobial resistance in the health care system. Infect Dis Clin N Am 1997;311:297–311.Google Scholar
19. Archibald, LK, Phillips, L, Monnet, D, McGowan, JE Jr, Tenover, F, Gaynes, R. Antimicrobial resistance in inpatients and outpatients in the United States: the increasing importance of the intensive care unit. Clin Infect Dis 1997;24:211–215.Google Scholar
20. Gaynes, R, Monnet, D. The contribution of antibiotic use on the frequency of antibiotic resistance in hospitals. In: Symposium on Antibiotic Resistance: Origins, Evolution, Selection, and Spread. Ciba Foundation Symposium 207, 07 16-18, 1996. London, England: John Wiley & Sons; 1997:47–56.Google Scholar
21. Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance (NNIS) System: description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
22. Pierson, CL, Friedman, BA. Comparison of susceptibility to beta-lactam antimicrobial agents among bacteria isolated from intensive care units. Diagn Microbiol Infect Dis 1992;15:19S-30S.Google Scholar
23. Stratton, CW IV, Ratner, H, Johnston, PE, Schaffner, W. Focused microbiologic surveillance by specific hospital unit: practical application and clinical utility. Clin Ther 1993;15(suppl A):12–20.Google ScholarPubMed
24. Goldmann, DA, Huskins, WC. Control of nosocomial antimicrobial-resistant bacteria: a strategic priority for hospitals worldwide. Clin Infect Dis 1997;24 (suppl 1):S139–S145.Google Scholar