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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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