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Do Intensive Hospital Antibiotic Control Programs Prevent the Spread of Antibiotic Resistance?

Published online by Cambridge University Press:  02 January 2015

John E. McGowan Jr
John E. McGowan Jr*
Affiliation:
Department of Pathology and Laboratory Medicine, Emory University School of Medicine, and the Clinical Microbiology Laboratory, Grady Memorial Hospital, Atlanta, Georgia
*
Clinical Laboratories, Box 26.248, Grady Memorial Hospital, 80 Butler St., Atlanta, GA 30335
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Abstract

The relation between antibiotic control and resistance was assessed by review of selected journal articles from 1988 through 1994. Most studies of control or monitoring do not report susceptibility pattern as an outcome measure. Several aspects of bias and confounding prevent more than analysis of temporal association between antibiotic use restriction and resistance pattern. However, in a few institutions there has been an increase in susceptibility to antimicrobials following intensive control or monitoring. Moreover, in a few hospitals, intensive antibiotic control for selected drug-organism pairs was associated with a high prevalence of susceptibility, and the proportion susceptible fell abruptly when control or monitoring was relaxed or removed. These examples, coupled with the recent emergence of new resistant organisms, justify attempts to determine the value of intensive antibiotic control as a preventive practice. Because these studies were performed in single institutions, their power to distinguish associations was poor. Cooperative multicenter studies are needed in which selection and classification biases are addressed prospectively, and in which confounding factors are controlled.

Type
From the Third International Conference on the Prevention of Infection
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 7 , July 1994 , pp. 478 - 483
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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References

1. Institute of Medicine. Emerging infections—Microbial Threats to Health in the United States. Washington, DC: National Academy Press; 1992.Google Scholar
2. Kunin, CM. Resistance to antimicrobial drugs-a worldwide calamity. Ann Intern Med 1993;118:557–561.CrossRefGoogle ScholarPubMed
3. McGowan, JE Jr Antibiotic resistance in hospital bacteria: current patterns, modes for appearance or spread, and economic impact. Rev Med Microbiol 1991;2:161–169.Google Scholar
4. O'Brien, T. Global surveillance of antibiotic resistance. N Engl J Med 1992;329:339–340.Google Scholar
5. Murray, BE. New aspects of antimicrobial resistance and the resulting therapeutic dilemmas. J Infect Dis 1991;163:1185–1194.CrossRefGoogle ScholarPubMed
6. Liss, RH. Batchelor, FR. Economic evaluations of antibiotic use and resistance-a perspective: report of Task Force 6. Rev Infect Dis 1987;9(suppl 3):S297–S312.Google Scholar
7. Sanders, CC, Sanders, WE Jr β-lactam resistance in gram-negative bacteria: global trends and clinical impact. C&Infect Dis 1992;15:824–839.Google Scholar
8. McGowan, JE Jr. Minimizing antimicrobial resistance in hospital bacteria: can switching or cycling drugs help? Infect Control 1986;7:573–576.CrossRefGoogle ScholarPubMed
9. Cohen, ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 1992;257:1050–1054.CrossRefGoogle ScholarPubMed
10. Magnusson, CR, Cave, J. Nosocomial enterococcal infections: association with use of third-generation cephalosporin antibiotics. Am J Infect Control 1988;16:241–245.Google Scholar
11. Marr, JJ, Moffet, HL, Kunin, CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 1988;157:869–876.Google Scholar
12. Johnson, MP, Ramphal, R. β-lactam-resistantEnterobacter bacteremia in febrile neutropenic patients receiving monotherapy. J Infect Dis 1990;162:981–983.CrossRefGoogle ScholarPubMed
13. Dans, PE, Charache, P. Inappropriate antimicrobial use in patients with positive blood cultures. Am J Med 1990;88:202.Google Scholar
14. Dunagan, WC, Woodward, RS, Medoff, G, et al. Antibiotic misuse in two clinical situations: positive blood culture and administration of aminoglycosides. Rev Infect Dis 1991;13:405–412.CrossRefGoogle ScholarPubMed
15. Frieden, TR, Mangi, RJ. Inappropriate use of oral ciprofloxacin. JAMA 1990;264:1438–1440.Google Scholar
16. Quintiliani, R, Klimek, JJ, Nightingale, CH. Restriction policies for therapy with combination antibiotics. J Infect Dis 1986;153:645–647.Google Scholar
17. Garibaldi, RA, Burke, J. Surveillance and control of antibiotic use in the hospital. Am J Infect Control 1991;19:164–170.Google Scholar
18. Gould, IM. Control of antibiotic use in the United Kingdom. J Antimicrob Chemother 1988;22:395–401.CrossRefGoogle ScholarPubMed
19. Ehrenkranz, NJ. Containing costs of antimicrobials in the hospital: a critical evaluation. Am J Infect Control 1989;17:300–310.Google Scholar
20. Dunagan, WC, Medoff, G. Formulary control of antimicrobial usage. What price freedom? Diagn Microbiol Infect Dis 1993;16:265–274.Google Scholar
21. Chren, M-M, Landefeld, CS. Physicians' behavior and their interactions with drug companies. A controlled study of physicians who requested additions to a hospital drug formulary. JAMA 1994;271:684–689.Google Scholar
22. O'Hanley, P, Easaw, J, Rugo, H, Easaw, S. Infectious disease management of acute leukemic patients undergoing chemotherapy: 1982 to 1986 experience at Stanford University Hospital. Am J Med 1989;87:605–613.Google Scholar
23. Klapp, DL, Ramphal, R. Antibiotic restriction in hospitals associated with medical schools. Am J Hosp Pharm 1983;40:1957–1960.Google Scholar
24. Beam, TR Jr Recent advances in curtailing costs of antimicrobial agents: an update on antimicrobial cost containment programs. Antimicrobic Newsletter 1988;5:17–21.Google Scholar
25. Hirschman, SZ, Meyers, BR, Bradbury, K, Mehl, B, Gendelman, S, Kimelblatt, B. Use of antimicrobial agents in a university teaching hospital. Evolution of a comprehensive control program. Arch Intern Med 1988;148:2001–2007.Google Scholar
26. Quintiliani, R, Nightingale, CH, Crowe, HM. Cooper, BW, Bartlett, RC, Gousse, G. Strategic antibiotic decision-making at the formulary level. Rev Infect Dis 1991;13(suppl 9):S770–777.Google Scholar
27. Briceland, LI, Nightingale, CH, Qunitiliani, R, Cooper, BW, Smith, KS. Antibiotic streamlining from combination therapy to monotherapy utilizing an interdisciplinary approach. Arch Intern Med 1988;148:2019–2022.CrossRefGoogle ScholarPubMed
28. Stratton, CW, Ratner, H, Johnston, PE, Schaffner, W. Focused microbiologic surveillance by specific hospital unit as a sensitive means of defining antimicrobial resistance problems. Diagn Microbiol Infect Dis 1992;15:11S–185.Google Scholar
29. Storm, AW. Effects of a restrictive antibiotic policy on clinical efficacy of antibiotics and susceptibility patterns of organisms. Eur J Clin Microbial Infect Dis 1990;9:381–389.Google Scholar
30. 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 Scholar
31. Ballow, CH, Schentag, JJ. Trends in antibiotic utilization and bacterial resistance. Report of the National Nosocomial Resistance Surveillance Group. Diagn Microbiol Infect Dis 1992;15:37S–42S.Google Scholar
32. Bamberger, DM, Dahl, SL. Impact of voluntary vs enforced compliance of third-generation cephalosporin use in a teaching hospital. Arch Intern Med 1992;152:554–557.Google Scholar
33. Jones, RN. The current and future impact of antimicrobial resistance among nosocomial bacterial pathogens. Diagn Microbiol Infect Dis 1992;15:3S–10S.Google Scholar
34. Riley, DK, Pestotnik, SL, Classen, DC, Stevens, LE. Burke, JP. The effect of improved prophylactic and therapeutic antibiotic use on hospital microbial resistance patterns. Infect Control Hosp Epidemiol 1994;15(4 Pt 2):P26. Abstract S2.Google Scholar
35. Silber, JL, Paul, SM, Crane, G, Kupersmit, A, Spitalny, K. Influence of hospital antibiotic policy and usage on the incidence of vancomycin-resistant enterococcal (VRE) bacteremia. Infect Control Hosp Epidemiol 1994;15(4 PI 2):P32. Abstract S51.Google Scholar
36. McGowan, JE Jr Is antimicrobial resistance in hospital microorganisms related to antibiotic use? Bull NY Acad Med 1987;63:253–268.Google Scholar
37. Freeman, J, Goldmann, DA, McGowan, JE Jr Confounding and the analysis of multiple variables in hospital epidemiology. Infect Control 1987;8:465–473.Google Scholar
38. Warren, JW. Providencia stuartii: a commcm cause of antibiotic-resistant bacteriuria in patients with long-term indwelling catheters. Rev Infect Dis 1986;8:61–67.Google Scholar
39. Hadom, K, Lenz, W, Kayser, FH, Shalit, I. Krasemann, C. Use of a ribosomal RNA gene probe for the epidemiological study of methicillin and ciprofloxacin resistant Staphylococcus aureus . Eur J Clin Microbiol Infect Dis 1990;9:649–653.Google Scholar
40. Skolnick, A. New insights into how bacteria develop antibiotic resistance. JAMA 1991;265:14–16.Google Scholar
41. Mayer, KH, Opal, SM. Unusual nosocomial pathogens. Infect Dis Clin N Am 1989;3:883–899.Google Scholar
42. Saravolatz, LD, Arking, L, Pohlod, D. An outbreak of gentamicin-resistant Klebsiella pneumoniae: analysis of contml measures. Infect Control 1984;5:79–84.Google Scholar
43. Weinstein, RA. Resistant bacteria and infection control in the nursing home and hospital. Bull NY Acad Med 1987;63:337–344.Google Scholar
44. Meyer, KS, Urban, C, Eagan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to late-generation cephalosporins. Ann Intern Med 1993;119:353–358.Google Scholar
45. Patterson, JE, Zervos, MJ. High-level gentamicin resistance in Enterococcus: microbiology, genetic basis, and epidemiology. Rev Infect Dis 1990;12:644–652.Google Scholar
46. Reish, O, Ashkenazi, S, Naor, N, Samra, Z, Merlob, P. An outbreak of multiresistant Klebsiella in a neonatal intensive care unit. J Hosp Infect 1993;25:287–291.Google Scholar
47. Gerding, DN. Larson, TA, Hughes, RA, Weiler, M, Shanholtzer, C, Peterson, LR. Aminoglycoside resistance and aminoglycoside usage: ten years of experience in one hospital. Antimicrob Agents Chemother 1991;35:1284–1290.CrossRefGoogle ScholarPubMed
48. Koontz, FP. Microbial resistance surveillance techniques. Blood culture versus multiple body site monitoring. Diagn Microbiol Infect Dis 1992;15:31S–35S.Google Scholar
49. Neu, HC. Infection problems for the 1990s—do we have an answer? Scand J Infect Dis 1993;91(suppl):7–13.Google Scholar
50. Craig, WA. Do antibiotic combinations prevent the emergence of resistant organisms? Infect Control Hosp Epidemiol 1988;9:417–419.Google Scholar
51. Barriere, SL. Bacterial resistance to β-lactams, and its prevention with combination antimicrobial therapy. Pharmacotherapy 1992;12:397–402.Google Scholar