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

Monnet, Dominique; Archibald, Lennox K.; Phillips, L; Tenover, F. C.; McGowan, John E.; Gaynes, Robert P.

doi:10.1086/647837

Cited by 78 publications

(17 citation statements)

References 19 publications

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“…Variations in MRSA proportions between hospitals within the same country have been reported ( 9 , 33 – 35 ), but to our knowledge, this is the first attempt to quantify variation between hospitals at the national level in a European study. We showed that considerable variation in MRSA proportions exists not only between countries but also between hospitals within a country.…”

Section: Discussionmentioning

confidence: 95%

“…Regional variation may also be explained by differences in diagnostic practice and culturing activity and random errors, which may artificially increase variation ( 39 ). Also, a differential case-mix attributable to differences in the level of care provided per hospital and differential referral practice may confound our estimates ( 9 , 35 , 40 ). However, unusually high variation in MRSA proportions between hospitals seems to occur most often in countries experiencing a current surge of MRSA.…”

Section: Discussionmentioning

confidence: 99%

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Methicillin-resistantStaphylococcus aureusin Europe, 1999–2002

Tiemersma

Bronzwaer²,

Lyytikäinen

et al. 2004

Emerg. Infect. Dis.

487

287

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Methicillin-resistantStaphylococcus aureusin Europe, 1999–2002

Tiemersma

Bronzwaer²,

Lyytikäinen

et al. 2004

Emerg. Infect. Dis.

487

287

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“…Pros for AUDs’ influence stressed that AUDs of broad-spectrum drugs were associated with their drug resistance 8. Yoon and colleagues9 described that a proportion of resistance in S. aureus was correlated to penicillin use.…”

Section: Discussionmentioning

confidence: 99%

Association between ward-specific antimicrobial use density and methicillin-resistant Staphylococcus aureus surveillance: a 60-month study

Yoshida¹,

Kikuchi²,

Matsubara³

et al. 2013

IDR

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It is not known whether or not ward-specific antimicrobial use density (AUD) affects the ratio of methicillin-resistant Staphylococcus aureus (MRSA) in culture-positive S. aureus. A 60-month study was attempted to ascertain the association between inpatient MRSA ratio and ward-specific AUDs as well as the former and latter study intervals, specimen types, and ward specialty. During the study, the professionals in infection control regulated the use of broad-spectrum antimicrobials and those for MRSA. By both month and ward, the ratio of inpatients positive for MRSA to those positive for S. aureus was calculated. Factors associated with MRSA ratio included AUDs averaged for the sampling month and its previous month, outpatient MRSA ratio by age, ward specialty, specimen type, and half intervals to represent historical changes. Of a total of 4,245 strains of S. aureus isolated during the 5-year study, 2,232 strains (52.6%) were MRSA. By year, outpatient MRSA ratio at age ≥15 decreased in later years, as did inpatient MRSA ratio. Multivariate analysis for inpatient MRSA ratio revealed a positive risk in AUDs for meropenem (odds ratio [OR] 1.761; 95% confidence interval [CI] 1.761–2.637, P = 0.01), imipenem-cilastatin (OR 1.583; 95% CI 1.087–2.306, P = 0.02), ampicillin-sulbactam (OR 1.623; 95% CI 1.114–2.365, P = 0.01), and minocycline (OR 1.680; CI 1.135–2.487, P = 0.01), respiratory care ward (OR 2.292; 95% CI 1.085–4.841, P = 0.03), and outpatient MRSA ratio (OR 1.536; 95% CI 1.070–2.206, P = 0.02). Use of broad-spectrum antimicrobials, such as meropenem, imipenem-cilastatin, and ampicillin-sulbactam may increase inpatient MRSA ratio. Ward factor should be included in MRSA surveillance because of the possible effect on AUD and considering patients’ backgrounds.

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“…A ntimicrobial resistance is a growing problem in many bacterial pathogens and is of particular concern for hospital-acquired (nosocomial) infections (1,2). Frequently, the bacteria responsible for nosocomial infections are members of the normal, usually commensal bacterial flora that become pathogenic when they multiply in normally sterile sites, such as the lower respiratory tract or the blood.…”

mentioning

confidence: 99%