title: Regional variations in fluoroquinolone non-susceptibility amongEscherichia colibloodstream infections within the Veterans Healthcare Administration.
abstract: OBJECTIVE
  We sought to define regional variations in fluoroquinolone non-susceptibility (FQ-NS) among bloodstream isolates ofEscherichia coliacross the Veterans Health Administration (VHA) in the United States.
  
  
  METHODS
  We analyzed a retrospective cohort of patients managed at 136 VHA hospitals who had a blood culture positive forE.colibetween 2003 and 2013. Hospitals were classified based on US Census Divisions, and regional variations in FQ-NS were analyzed.
  
  
  RESULTS
  Twenty-four thousand five hundred twenty-three uniqueE.colibloodstream infections (BSIs) were identified between 2003 and 2013. 53.9 % of these were community-acquired, 30.7 % were healthcare-associated, and 15.4 % were hospital-onset BSIs. The proportion ofE.coliBSIs with FQ-NS significantly varied across US Census Divisions (p< 0.001). During 2003-2013, the proportion ofE.coliBSIs with FQ-NS was highest in the West South-Central Division (32.7 %) and lowest in the Mountain Division (20.0 %). Multivariable analysis showed that there were universal secular trends towards higher FQ-NS rates (p< 0.001) with significant variability of slopes across US Census Divisions (p< 0.001).
  
  
  CONCLUSIONS
  There has been a universal increase in FQ-NS amongE.coliBSIs within VHA, but the rate of increase has significantly varied across Census Divisions. The reasons for this variability are unclear. These findings reinforce the importance of using local data to develop and update local antibiograms and antibiotic-prescribing guidelines.
authors: Iowa City VA Health Care System, Iowa City, IA USA ; Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242 USA.
authors: Daniel J
authors: DJ
authors: Livorsi
authors: Iowa City VA Health Care System, Iowa City, IA USA ; Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242 USA.
authors: Michihiko
authors: M
authors: Goto
authors: Department of Geographical and Sustainability Sciences, College of Liberal Arts and Sciences, University of Iowa, Iowa City, IA USA.
authors: Margaret
authors: M
authors: Carrel
authors: Salt Lake City VA Health Care System, Salt Lake City, UT USA ; University of Utah School of Medicine, Salt Lake City, UT USA.
authors: Makoto M
authors: MM
authors: Jones
authors: Iowa City VA Health Care System, Iowa City, IA USA ; Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA USA.
authors: Jennifer
authors: J
authors: McDanel
authors: Iowa City VA Health Care System, Iowa City, IA USA ; Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA.
authors: Rajeshwari
authors: R
authors: Nair
authors: Iowa City VA Health Care System, Iowa City, IA USA.
authors: Bruce
authors: B
authors: Alexander
authors: Iowa City VA Health Care System, Iowa City, IA USA.
authors: Brice
authors: B
authors: Beck
authors: Iowa City VA Health Care System, Iowa City, IA USA.
authors: Kelly K
authors: KK
authors: Richardson
authors: Iowa City VA Health Care System, Iowa City, IA USA ; Division of General Internal Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA.
authors: Eli N
authors: EN
authors: Perencevich
keywords: Antimicrobial resistance; Epidemiology; Escherichia coli; Fluoroquinolones