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Variation in the Use of Procedures to Monitor Antimicrobial Resistance in U.S. Hospitals

Published online by Cambridge University Press:  21 June 2016

Stephen D. Flach ,
Daniel J. Diekema ,
Jon W. Yankey ,
Bonnie J. BootsMiller ,
Thomas E. Vaughn ,
Erika J. Ernst ,
Marcia M. Ward  and
Bradley N. Doebbeling
Stephen D. Flach*
Affiliation:
Iowa City Veterans Affairs Medical Center, Iowa City, Iowa University of Iowa, Public Policy Center, Iowa City, Iowa University of Iowa Carver College of Medicine, Iowa City, Iowa
Daniel J. Diekema
Affiliation:
Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Jon W. Yankey
Affiliation:
Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Bonnie J. BootsMiller
Affiliation:
Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Thomas E. Vaughn
Affiliation:
University of Iowa College of Public Health, Iowa City, Iowa
Erika J. Ernst
Affiliation:
University of Iowa College of Pharmacy, Iowa City, Iowa
Bradley N. Doebbeling
Affiliation:
HSR&D Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center the Regenstrief Institute Inc., Indiana University Center for Health Services and Outcomes Research, Indiana University School of Medicine, Indianapolis, Indiana
*
Department of Internal Medicine, SE 629 GH, University of Iowa College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242[email protected]
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Abstract

Background:

Antimicrobial resistance is a growing clinical and public health crisis. Experts have recommended measures to monitor antimicrobial resistance; however, little is known regarding their use.

Objective:

We describe the use of procedures to detect and report antimicrobial resistance in U.S. hospitals and the organizational and epidemiologic factors associated with their use.

Methods:

In 2001, we surveyed laboratory directors (n = 108) from a random national sample of hospitals. We studied five procedures to monitor antimicrobial resistance: (1) disseminating antibiograms to physicians at least annually, (2) notifying physicians of antimicrobial-resistant infections, (3) reporting susceptibility results within 24 hours, (4) using automated testing procedures, and (5) offering molecular typing. Explanatory variables included organizational characteristics and patterns of antimicrobial resistance for oxacillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, quinolone-resistant Escherichia coli, and extended-spectrum beta-lactamase-producing Klebsiella species. Generalized estimating equations accounting for the correlation among outcomes at the facility level were used to identify predictors of the five outcomes.

Results:

Use of the procedures ranged from 85% (automated testing) to 33% (offering molecular typing) and was related to teaching hospital status (OR, 3.1; CI95, 1.5–6.5), participation of laboratory directors on the infection control committee (OR, 1.7; CI95, 1.1–2.8), and having at least one antimicrobial-resistant pathogen with a prevalence greater than 10% (OR, 2.2; CI95, 1.4–3.3).

Conclusion:

U.S. hospitals underutilize procedures to monitor the spread of antimicrobial resistance. Use of these procedures varies and is related to organizational and epidemiologic factors. Further efforts are needed to increase their use by hospitals.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 31 - 38
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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