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Antimicrobial Use Control Measures to Prevent and Control Antimicrobial Resistance in US Hospitals

Published online by Cambridge University Press:  21 June 2016

Alan J. Zillich ,
Jason M. Sutherland ,
Stephen J. Wilson ,
Daniel J. Diekema ,
Erika J. Ernst ,
Thomas E. Vaughn  and
Bradley N. Doebbeling
Alan J. Zillich*
Affiliation:
Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa Veterans Affairs Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa Indiana University Center for Outcomes Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa
Jason M. Sutherland
Affiliation:
Veterans Affairs Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa Indiana University Center for Outcomes Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa Division of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa
Stephen J. Wilson
Affiliation:
Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa
Daniel J. Diekema
Affiliation:
Departments of Internal Medicine and Pathology, Iowa City Veterans Affairs Medical Center andUniversity of Iowa Roy A. and Lucille J. Carver College of Medicine, Iowa City, Iowa
Erika J. Ernst
Affiliation:
Division of Clinical and Administrative Pharmacy, University of Iowa College of Pharmacy, Iowa City, Iowa
Thomas E. Vaughn
Affiliation:
Department of Health Management and Policy, University of Iowa College of Public Health, Iowa City, Iowa
Bradley N. Doebbeling
Affiliation:
Veterans Affairs Health Services Research and Development Center on Implementing Evidence-Based Practice, Roudebush Veterans Affairs Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa Indiana University Center for Outcomes Research, Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, Iowa City, Iowa
*
Purdue University, Pharmacy Programs—Indianapolis, W7555, Myers Building, 1001 West 10th Street, Indianapolis, IN 46202, (azillich@purdue.edu)
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Objective.

Clinical practice guidelines and recommended practices to control use of antibiotics have been published, but the effect of these practices on antimicrobial resistance (AMR) rates in hospitals is unknown. The objective of this study was to examine relationships between antimicrobial use control strategies and AMR rates in a national sample of US hospitals.

Design.

Cross-sectional, stratified study of a nationally representative sample of US hospitals.

Methods.

A survey instrument was sent to the person responsible for infection control at a sample of 670 US hospitals. The outcome was current prevalences of 4 epidemiologically important, drug-resistant pathogens, considered concurrently: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci, ceftazidime-resistant Klebsiella species, and quinolone (ciprofloxacin)-resistant Escherichia coli Five independent variables regarding hospital practices were selected from the survey: the extent to which hospitals (1) implement practices recommended in clinical practice guidelines and ensure best practices for antimicrobial use, (2) disseminate information on clinical practice guidelines for antimicrobial use, (3) use antimicrobial-related information technology, (4) use decision support tools, and (5) communicate to prescribers about antimicrobial use. Control variables included the hospitals' number of beds, teaching status, Veterans Affairs status, geographic region, and number of long-term care beds; and the presence of an intensive care unit, a burn unit, or transplant services. A generalized estimating equation modeled all resistance rates simultaneously to identify overall predictors of AMR levels at the facility.

Results.

Completed survey instruments were returned by 448 hospitals (67%). Four antimicrobial control measures were associated with higher prevalence of AMR. Implementation of recommended practices for antimicrobial use (P< .01) and optimization of the duration of empirical antibiotic prophylaxis (P<.01) were associated with a lower prevalence of AMR. Use of restrictive formularies (P = .05) and dissemination of clinical practice guideline information (P<.01) were associated with higher prevalence of AMR. Number of beds and Veterans Affairs status were also associated with higher AMR rates overall.

Conclusions.

Implementation of guideline-recommended practices to control antimicrobial use and optimize the duration of empirical therapy appears to help control AMR rates in US hospitals. A longitudinal study would confirm the results of this cross-sectional study. These results highlight the need for systems interventions and reengineering to ensure more-consistent application of guideline-recommended measures for antimicrobial use.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1088 - 1095
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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