title: Antimicrobial resistance trends and outbreak frequency in United States hospitals.
abstract: We assessed resistance rates and trends for important antimicrobial-resistant pathogens (oxacillin-resistant Staphylococcus aureus [ORSA], vancomycin-resistant Enterococcus species [VRE], ceftazidime-resistant Klebsiella species [K-ESBL], and ciprofloxacin-resistant Escherichia coli [QREC]), the frequency of outbreaks of infection with these resistant pathogens, and the measures taken to control resistance in a stratified national sample of 670 hospitals. Four hundred ninety-four (74%) of 670 surveys were returned. Resistance rates were highest for ORSA (36%), followed by VRE (10%), QREC (6%), and K-ESBL (5%). Two-thirds of hospitals reported increasing ORSA rates, whereas only 4% reported decreasing rates, and 24% reported ORSA outbreaks within the previous year. Most hospitals (87%) reported having implemented measures to rapidly detect resistance, but only approximately 50% reported having provided appropriate resources for antimicrobial resistance prevention (53%) or having implemented antimicrobial use guidelines (60%). The most common resistant pathogen in US hospitals is ORSA, which accounts for many recognized outbreaks and is increasing in frequency in most facilities. Current practices to prevent and control antimicrobial resistance are inadequate.
authors.affiliation: Iowa City Veterans Affairs Medical Center, Dept. of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA. daniel-diekema@uiowa.edu
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Diekema
authors.forename: Bonnie J
authors.initials: BJ
authors.lastname: BootsMiller
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Vaughn
authors.forename: Robert F
authors.initials: RF
authors.lastname: Woolson
authors.forename: Jon W
authors.initials: JW
authors.lastname: Yankey
authors.forename: Erika J
authors.initials: EJ
authors.lastname: Ernst
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Flach
authors.forename: Marcia M
authors.initials: MM
authors.lastname: Ward
authors.forename: Carrie L J
authors.initials: CL
authors.lastname: Franciscus
authors.forename: Michael A
authors.initials: MA
authors.lastname: Pfaller
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D003625:Data Collection; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000502:physiology*; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents