Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-28T01:53:51.011Z Has data issue: false hasContentIssue false
  • English
  • Français

Trends in Aminoglycoside Use and Gentamicin-Resistant Gram-Negative Clinical Isolates in US Academic Medical Centers: Implications for Antimicrobial Stewardship

Published online by Cambridge University Press:  02 January 2015

Mera Ababneh ,
Spencer Harpe ,
Michael Oinonen  and
Ron E. Polk
Mera Ababneh
Affiliation:
Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
Spencer Harpe
Affiliation:
Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
Michael Oinonen
Affiliation:
University HealthSystem Consortium, Chicago, Illinois
Ron E. Polk*
Affiliation:
Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
*
VCU School of Pharmacy/MCV Campus, 410 North 12th Street, PO Box 980533, Richmond, VA 23298 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To measure trends in aminoglycoside antibiotic use and gentamicin-resistant clinical isolates across a network of hospitals and compare network-level relationships with those of individual hospitals.

Design.

Longitudinal observational investigation.

Setting.

US academic medical centers.

Participants.

Adult inpatients.

Methods.

Adult aminoglycoside use was measured from 2002 or 2003 through 2009 in 29 hospitals. Hospital-wide antibiograms assessed gentamicin resistance by proportions and incidence rates for Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Mixed-effects analysis of variance was used to assess the significance of changes in aminoglycoside use and changes in resistance rates and proportions. Generalized estimating equations were used to assess the relationship between aminoglycoside use and resistance.

Results.

Mean aminoglycoside use declined by 41%, reflecting reduced gentamicin (P <.0001) and tobramycin (P = .005) use; amikacin use did not change. The rate and proportion of gentamicin-resistant P. aeruginosa decreased by 48% (P < .0001) and 31% (P < .0001), respectively. The rate and proportion of gentamicin-resistant E. coli increased by 166% and 124%, respectively (P < .0001), and they were related to increasing quinolone resistance in E. coli. Resistance among K. pneumoniae and A. baumannii did not change. Relationships between aminoglycoside use and resistance at the network level were highly variable at the individual hospital level.

Conclusions.

Mean aminoglycoside use declined in this network of US hospitals and was associated with significant and opposite changes in rates of resistance for some organisms and no change for others. At the individual hospital level, antibiograms appear to be an unreliable reflection of antibiotic use, at least for aminoglycosides.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 6 , June 2012 , pp. 594 - 601
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1–12.Google Scholar
2. Drusano, GL, Ambrose, P, Louie, A. Optimization of aminoglycoside therapy. Antimicrob Agents Chemother 2011;55:2528–2531.Google Scholar
3. Leibovici, L, Vidal, L, Paul, M. Aminoglycoside drugs in clinical practice: an evidence-based approach. J Antimicrob Chemother 2009;63:246–251.Google Scholar
4. Mueller, EW, Boucher, BA. The use of extended-interval aminoglycoside dosing strategies for the treatment of moderate-to-severe infections encountered in critically ill surgical patients. Surg Infect (Larchmt) 2009;10:563–570.Google Scholar
5. Pakyz, AL, MacDougall, C, Oinonen, M, Polk, RE. Trends in antibacterial use in US academic health centers: 2002 to 2006. Arch Intern Med 2008;168:2254–2260.Google Scholar
6. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
7. Rhomberg, PR, Jones, RN. Summary trends for the Meropenem Yearly Susceptibility Test Information Collection program: a 10-year experience in the United States (1999-2008). Diagn Microbiol Infect Dis 2009;65:414–426.Google Scholar
8. Hidron, AI, Edwards, JR, Patel, J, et al; National Healthcare Safety Network Team and Participating National Healthcare Safety Network Facilities. Antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996–1011.Google Scholar
9. Weinstein, R, Nathan, C, Gruensfelder, R, Kabins, SA. Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms. J Infect Dis 1980;141:338–345.Google Scholar
10. Young, EJ, Sewell, CM, Koza, MA, Clarridge, JE. Antibiotic resistance patterns during aminoglycoside restriction. Am J Med Sci 1985;290:223–227.Google Scholar
11. 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.Google Scholar
12. Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664–670.Google Scholar
13. Schwaber, MJ, De-Medina, T, Carmeli, Y. Epidemiological interpretation of antibiotic resistance studies-what are we missing? Nat Rev Microbiol 2004;2:979–983.10.1038/nrmicro1047Google Scholar
14. D'Agata, EM, Cataldo, MA, Cauda, R, Tacconelli, E. The importance of addressing multidrug resistance and not assuming single-drug resistance in case-control studies. Infect Control Hosp Epidemiol 2006;27:670–674.Google Scholar
15. Neuhauser, MM, Weinstein, RA, Rydman, R, et al. Antibiotic resistance among gram-negative bacilli in US intensive care units: implications for fluoroquinolone use. JAMA 2003;289: 885–888.Google Scholar
16. Lautenbach, E, Strom, BL, Bilker, WB, Patel, JB, Edelstein, PH, Fishman, NO. Epidemiological investigation of fluoroquinolone resistance in infections due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae . Clin Infect Dis 2001;33:1288–1294.Google Scholar
17. Paramythiotou, E, Lucet, J-C, Timsit, JF, et al. Acquisition of multidrug-resistant Pseudomonas aeruginosa in patients in intensive care units: role of antibiotics with antipseudomonal activity. Clin Infect Dis 2004;38:670–677.Google Scholar
18. Krueger, C, Tian, L. A comparison of the general linear mixed model and repeated measures ANOVA using a dataset with multiple missing data points. Biol Res Nurs 2004;6:151–157.Google Scholar
19. Pan, W. Akaike's Information Criterion in generalized estimating equations. Biometrics 2001;57:120–125.Google Scholar
20. Cui, J. QIC program and model selection in GEE analyses. Stata J 2007;7:209–220.Google Scholar
21. McGowan, J Jr. Do intensive hospital antibiotic control programs prevent the spread of antibiotic resistance? Infect Control Hosp Epidemiol 1994;15:478–483.Google Scholar
22. Fridkin, SK, Lawton, R, Edwards, JR, et al. Monitoring antimicrobial use and resistance: comparison with a national benchmark on reducing vancomycin use and vancomycin-resistant enterococci. Emerg Infect Dis 2002;8:702–707.Google Scholar
23. Turnidge, J, Christiansen, C. Antibiotic use and resistance-proving the obvious. Lancet 2005;365:548–549.Google Scholar
24. Yong, MK, Buising, KL, Cheng, AC, Thursky, KA. Improved susceptibility of gram-negative bacteria in an intensive care unit following implementation of a computerized antibiotic decision support system. J Antimicrob Chemother 2010;65:1062–1069.Google Scholar
25. Biedenbach, DJ, Jones, RN, Miller, GH, Armstrong, ES. Ten year trend in aminoglycoside resistance from a worldwide collection of gram-negative pathogens (1998-2007). Presented at: 19th annual meeting of the European Congress of Clinical Microbiology and Infectious Diseases, May 16-19, 2009, Helsinki. Abstract 636.Google Scholar
26. Strahilevitz, J, Jacoby, GA, Hooper, DC, Robicsek, A. Plasmid-mediated quinolone resistance: a multifaceted threat. Clin Micro Rev 2009;22:664–689.Google Scholar
27. Research Committee of the Society of Healthcare Epidemiology of America, Sinaii, N. Charting the course for the future of science in healthcare epidemiology: results of a survey of the membership of the Society of Healthcare Epidemiology of America. Infect Control Hosp Epidemiol 2010;31:669–675.Google Scholar
28. Dellit, T, Owens, R, McGowen, J, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44: 159–177.Google Scholar
29. Jorgensen, JH, Ferrara, MJ. Antimicrobial susceptibility testing: a review of general principles and contemporary practices. Clin Infect Dis 2009;49:1749–1755.Google Scholar
30. Cook, PP, Catrou, PG, Christie, JD, Young, PD, Polk, RE. Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram. J Antimicrob Chemother 2004;53:853–859.Google Scholar
31. Zahar , J-R, Rioux, C, Girou, E, et al. Inappropriate prescribing of aminoglycosides: risk factors and impact of an antibiotic control team. J Antimicrob Chemother 2006;58:651–656.Google Scholar
32. Stone, SP, Cooper, BS, Kibbler, CC, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. J Antimicrob Chemother 2007;59:833–840.Google Scholar
33. White, AC, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230–239.Google Scholar
34. White, RL, Friedrich, LV, Mihm, LB, Bosso, JA. Assessment of the relationship between antimicrobial usage and susceptibility: differences between the hospital and specific patient-care areas. Clin Infect Dis 2000;31:16–23.Google Scholar
35. Harbarth, S, Harris, AD, Carmeli, Y, Samore, MH. Parallel analysis of individual and aggregated data on antibiotic exposure and resistance in gram-negative bacilli. Clin Infect Dis 2001;33: 1462–1468.Google Scholar
36. Fridkin, SK, Edwards, JR, Tenover, FC, et al. Antimicrobial resistance prevalence rates in hospital antibiograms reflect prevalence rates among pathogens associated with hospital-acquired infections. Clin Infect Dis 2001;33:324–330.Google Scholar
37. Mutnick, AH, Rhomberg, PR, Sader, HS, Jones, RN. Antimicrobial usage and resistance trend relationships from the MYSTIC Programme in North America (1999-2001). J Antimicrob Chemother 2004;53:290–296.Google Scholar
38. Epstein, BJ, Gums, JG, Turner, PJ, Feldgarden, M, Hou, W. Integrating susceptibility data from two surveillance programs with unique methodological techniques: the Antibiogram Resistance Method or Isolate-Based Resistance Monitoring (ARMOR) Study Group. Hosp Pharm 2007;42:435–446.Google Scholar
39. Fridkin, SK, Hill, HA, Volkova, NV, et al; Intensive Care Antimicrobial Resistance Epidemiology (ICARE) Project Hospitals. Temporal changes in prevalence of antimicrobial resistance in 23 US hospitals. Emerg Infect Dis 2002;8:679–701.Google Scholar
40. Hindier, JF, Stelling, J. Analysis and presentation of cumulative antibiograms: a new consensus guideline from the Clinical and Laboratory Standards Institute. Clin Infect Dis 2007;44:867–873.Google Scholar
41. Fishbain, J, Pelog, AY. Treatment of Acinetobacter infections. Clin Infect Dis 2010;51:79–84.Google Scholar
42. Jhung, MA, Banerjee, SN. Administrative coding data and health care-associated infections. Clin Infect Dis 2009;49:949–955.Google Scholar