title: Streptococcus pneumoniae non-susceptibility and outpatient antimicrobial prescribing rates at the Alaska Native Medical Center.
abstract: BACKGROUND
  American Indian/Alaska Native (AI/AN) people suffer substantially higher rates of invasive pneumococcal disease (IPD) than the general US population. We evaluated antimicrobial prescribing data and their association with non-susceptibility in Streptococcus pneumoniae causing IPD in AI/AN people between 1992 and 2009.
  
  
  METHODS
  Antimicrobial use data were gathered from the electronic patient management system and included all prescriptions dispensed to Alaska Native patients aged 5 years and older from outpatient pharmacies at the Alaska Native Medical Center (ANMC). Antimicrobial susceptibility data were gathered from pneumococcal isolates causing IPD among Anchorage Service Unit AI/AN residents aged 5 years and older. Data were restricted to serotypes not contained in the pneumococcal vaccine (PCV7).
  
  
  RESULTS
  Over the study period, overall antimicrobial prescribing increased 59% (285/1,000 persons/year in 1992 to 454/1,000 persons per year in 2009, p<0.001). Trimethoprim/sulfamethoxazole prescribing increased (43/1,000 persons/year in 1992 to 108/1,000 persons/year in 2009, p<0.001) and non-susceptibility to trimethoprim/sulfamethoxazole in AI/AN patients ≥5 years of age increased in non-PCV7 serotypes (0-12%, p<0.05). Similarly, prescribing rates increased for macrolide antibiotics (46/1,000 persons/year in 1992 to 84/1,000 persons/year in 2009, p<0.05). We observed no statistically significant change over time in erythromycin non-susceptibility among non-PCV7 serotypes in AI/AN patients aged 5 years or greater (0-7%, p=0.087).
  
  
  CONCLUSIONS
  Antimicrobial prescribing patterns of some antibiotics in the AI/AN population corresponded to increased antimicrobial resistance in clinical isolates. This study highlights the on-going threat of antimicrobial resistance, the critical importance of judicious prescribing of antibiotics and the potential utility of prescribing data for addressing this issue.
authors.affiliation: Alaska Native Medical Center, Anchorage, AK, USA.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Stevens
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Wenger
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bulkow
authors.affiliation: Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Disease, Centers for Disease Control and Prevention (CDC), Anchorage, AK, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
mesh_terms: D000293:Adolescent; D000413:Alaska / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D006303:Health Services, Indigenous / Q000706:statistics & numerical data*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007198:Indians, North American; D004930:Inuit; D010044:Outpatient Clinics, Hospital; D011008:Pneumococcal Infections / Q000188:drug therapy* / Q000208:ethnology; D022242:Pneumococcal Vaccines / Q000008:administration & dosage* / Q000009:adverse effects / Q000276:immunology; D013296:Streptococcus pneumoniae / Q000187:drug effects* / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022242:Pneumococcal Vaccines
keywords: Alaska; Alaska Natives; Streptococcus pneumoniae; antibiotic prescribing; antibiotic resistance; invasive pneumococcal disease; susceptibility