title: Does antimicrobial resistance cluster in individual hospitals?
abstract: Factors that affect the resistance rates for an organism-drug combination in a given hospital also might influence resistance rates for other organism-drug combinations. We examined correlations between resistance prevalence in non-intensive care inpatient areas of 41 hospitals participating in phase 3 (1998-1999) of Project ICARE (Intensive Care Antimicrobial Resistance Epidemiology). We focused on statistically significant (P<.05) Pearson correlation coefficients for methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci, vancomycin-resistant enterococci, and resistance to third-generation cephalosporins, imipenem, and fluoroquinolones in Escherichia coli, Klebsiella pneumoniae, Enterobacter species, and Pseudomonas aeruginosa. Resistance prevalence rates in individual hospitals were not strongly correlated among gram-positive organisms, and few correlations were seen between rates in gram-positive and gram-negative organisms. More frequent significant associations were found among resistance rates for gram-negative organisms. Resistance to third-generation cephalosporins in K. pneumoniae was significantly correlated with the majority of other sentinel antimicrobial-resistant organisms. High prevalence of this organism may serve as a marker for more generalized resistance problems in hospital inpatient areas.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322, USA. jmcgowa@sph.emory.edu
authors.forename: John E
authors.initials: JE
authors.lastname: McGowan
authors.forename: Holly A
authors.initials: HA
authors.lastname: Hill
authors.forename: Nataliya V
authors.initials: NV
authors.lastname: Volkova
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Lawton
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Haber
authors.forename: Fred C
authors.initials: FC
authors.lastname: Tenover
authors.forename: Robert P
authors.initials: RP
authors.lastname: Gaynes
mesh_terms: D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000276:immunology* / Q000517:prevention & control; D006090:Gram-Negative Bacteria / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000302:isolation & purification*; D006761:Hospitals; D006801:Humans; D007113:Immunity, Innate / Q000276:immunology*; D015995:Prevalence; D014481:United States