Abstract
Antimicrobial resistance is increasing in nearly all health-care–associated pathogens. We examined changes in resistance prevalence during 1996–1999 in 23 hospitals by using two statistical methods. When the traditional chi-square test of pooled mean resistance prevalence was used, most organisms appear to have increased in prevalence. However, when a more conservative test that accounts for changes within individual hospitals was used, significant increases in prevalence of resistance were consistently observed only for oxacillin-resistant Staphylococcus aureus, ciprofloxacin-resistant Pseudomonas aeruginosa, and ciprofloxacin- or ofloxacin-resistant Escherichia coli. These increases were significant only in isolates from patients outside intensive-care units (ICU). The increases seen are of concern; differences in factors present outside ICUs, such as excessive quinolone use or inadequate infection-control practices, may explain the observed trends.
Highlights
Antimicrobial resistance is increasing in most health-care–associated pathogens
Hospitals participating in the intensive-care units (ICU) surveillance component of the National Nosocomial Infections Surveillance (NNIS) system were invited to participate in the second (January 1996 through December 1997) and third (April 1998 through July 1999) phases of Project Intensive Care Antimicrobial Resistance Epidemiology (ICARE)
In non-ICU inpatient areas, significant increases in median resistance rates were noted for oxacillin-resistant Staphylococcus aureus (ORSA) (8.2%), ciprofloxacin-resistant P. aeruginosa (3.3%), and ciprofloxacin-resistant E. coli (0.6%) (Table)
Summary
Antimicrobial resistance is increasing in most health-care–associated pathogens. When a more conservative test that accounts for changes within individual hospitals was used, significant increases in prevalence of resistance were consistently observed only for oxacillin-resistant Staphylococcus aureus, ciprofloxacin-resistant Pseudomonas aeruginosa, and ciprofloxacin- or ofloxacin-resistant Escherichia coli. These increases were significant only in isolates from patients outside intensive-care units (ICU). Several statistical tests can be used to evaluate changes in antimicrobial-resistance prevalence; chi-square is commonly used but does not account for consistency of trends in all hospitals. To determine consistency of changes in antimicrobial-resistance patterns over time in a national monitoring project, we used two statistical methods to evaluate national antimicrobial-resistance data over a 4-year period, as well as assess consistency within hospitals
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