title: Carbapenem-resistant Enterobacteriaceae and the correlation between carbapenem and fluoroquinolone usage and resistance in the US military health system.
abstract: Whether carbapenem or fluoroquinolone usage is correlated with carbapenem-resistant Enterobacteriaceae (CRE) has not been investigated at the level of an entire US nationwide managed health care system. We analyzed 75 million person-years of surveillance and 1,969,315 cultures from all 266 hospitals in the geographically dispersed US military health system. Incidences of CRE remained under 1 case per 100,000 person-years. Incidences of CRE increased relative to 2005 baseline levels in 3 of 7 subsequent years, then decreased in 2012 (P<0.05). Incident proportions of carbapenem resistance (CR) differed significantly among years, geographical regions, and bacterial species. Although use and resistance strongly correlated (R>0.80) for several "drug-bug" combinations, none were significant at the national or facility level. One exception was that inpatient consumption of fluoroquinolones was significantly correlated (P=0.0007) with CR in Escherichia coli when data from the major referral centers of the Southern and Northern regions were combined.
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA. Electronic address: carolinelesho@yahoo.com.
authors.forename: Emil P
authors.initials: EP
authors.lastname: Lesho
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Clifford
authors.affiliation: EpiData Center Department, Navy and Marine Corps Public Health Center, Portsmouth, VA, USA.
authors.forename: Uzo
authors.initials: U
authors.lastname: Chukwuma
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Yoon I
authors.initials: YI
authors.lastname: Kwak
authors.affiliation: US Army Pharmacovigilance Center, Falls Church, VA, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Maneval
authors.affiliation: EpiData Center Department, Navy and Marine Corps Public Health Center, Portsmouth, VA, USA.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Neumann
authors.affiliation: US Army Pharmacovigilance Center, Falls Church, VA, USA.
authors.forename: Suji
authors.initials: S
authors.lastname: Xie
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Nielsen
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Julius
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Patrick
authors.initials: P
authors.lastname: McGann
authors.affiliation: Multidrug-resistant organism Repository & Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
authors.forename: Paige E
authors.initials: PE
authors.lastname: Waterman
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D024841:Fluoroquinolones / Q000494:pharmacology*; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D008889:Military Personnel; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D024841:Fluoroquinolones
keywords: Antibiotic consumption; Antibiotic use; Carbapenem resistance; Healthcare network