title: Hospital-Acquired Methicillin-resistantStaphylococcus aureusBacteremia Related to Medicare Antibiotic Prescriptions: A State-Level Analysis.
abstract: Methicillin-resistantStaphylococcus aureus(MRSA) results in almost half of all deaths caused by antibiotic resistant organisms. Current evidence suggests that MRSA infections are associated with antibiotic use. This study examined state-level data to determine whether outpatient antibiotic use was associated with hospital-acquired MRSA (HA-MRSA) infections. The 2013 Centers for Disease Control and Prevention (CDC) Healthcare-Associated Infections Progress Report was used to obtain HA-MRSA infection rates. Data on the number of antibiotic prescriptions with activity towards methicillin-sensitiveStaphylococcus aureus(MSSA) at the state level were obtained from the 2013 Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File. Pearson's correlation coefficient was used to analyze the relationship between the number of antibiotic prescriptions and HA-MRSA infection rates. The average number of HA-MRSA infections was 0.026 per 1000 persons with the highest rates concentrated in Southeastern and Northeastern states. The average number of outpatient prescriptions per capita was 0.74 with the highest rates in Southeastern states. A significant correlation (ρ = 0.64,P<.001) between infections and prescriptions was observed, even after adjusting for non-reporting hospitals. This association provides evidence of the importance of appropriate antibiotic prescribing. Prescriber and heat map data may be useful for targeting antimicrobial stewardship programs in an effort to manage appropriate antibiotic use to help stop antibiotic resistance.
authors.affiliation: Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT).
authors.forename: Bryce T
authors.initials: BT
authors.lastname: Fukunaga
authors.affiliation: Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT).
authors.forename: Wesley K
authors.initials: WK
authors.lastname: Sumida
authors.affiliation: Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT).
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Taira
authors.affiliation: Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT).
authors.forename: James W
authors.initials: JW
authors.lastname: Davis
authors.affiliation: Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT).
authors.forename: Todd B
authors.initials: TB
authors.lastname: Seto
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data*; D055624:Methicillin-Resistant Staphylococcus aureus; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000209:etiology*; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Antimicrobial stewardship; Medicare; Methicillin-resistant Staphylococcus aureus; Methicillin-sensitive Staphylococcus aureus