title: Optimizing antimicrobial prescribing: Are clinicians following national trends in methicillin-resistant staphylococcus aureus (MRSA) infections rather than local data when treating MRSA wound infections.
abstract: BACKGROUND
  Clinicians often prescribe antimicrobials for outpatient wound infections before culture results are known. Local or national MRSA rates may be considered when prescribing antimicrobials. If clinicians prescribe in response to national rather than local MRSA trends, prescribing may be improved by making local data accessible. We aimed to assess the correlation between outpatient trends in antimicrobial prescribing and the prevalence of MRSA wound infections across local and national levels.
  
  
  METHODS
  Monthly MRSA positive wound culture counts were obtained from The Surveillance Network, a database of antimicrobial susceptibilities from clinical laboratories across 278 zip codes from 1999-2007. Monthly outpatient retail sales of linezolid, clindamycin, trimethoprim-sulfamethoxazole and cephalexin from 1999-2007 were obtained from the IMS Health XponentTM database. Rates were created using census populations. The proportion of variance in prescribing that could be explained by MRSA rates was assessed by the coefficient of determination (R2), using population weighted linear regression.
  
  
  RESULTS
  107,215 MRSA positive wound cultures and 106,641,604 antimicrobial prescriptions were assessed. The R2 was low when zip code-level antimicrobial prescription rates were compared to MRSA rates at all levels. State-level prescriptions of clindamycin and linezolid were not correlated with state MRSA rates. The variance in state-level prescribing of clindamycin and linezolid was correlated with national MRSA rates (clindamycin R2 = 0.17, linezolid R2 = 0.22).
  
  
  CONCLUSIONS
  Clinicians may rely on national, not local MRSA data when prescribing clindamycin and linezolid for wound infections. Providing local resistance data to prescribing clinicians may improve antimicrobial prescribing and would be a possible target for future interventions.
authors.affiliation: Iowa City VA Health Care System, Iowa City, IA, USA. marin-schweizer@uiowa.edu.
authors.forename: Marin L
authors.initials: ML
authors.lastname: Schweizer
authors.forename: Eli N
authors.initials: EN
authors.lastname: Perencevich
authors.forename: Michael R
authors.initials: MR
authors.lastname: Eber
authors.forename: Xueya
authors.initials: X
authors.lastname: Cai
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Shardell
authors.forename: Nikolay
authors.initials: N
authors.lastname: Braykov
authors.forename: Ramanan
authors.initials: R
authors.lastname: Laxminarayan