NDLI: Trends in aminoglycoside use and gentamicin-resistant gram-negative clinical isolates in US academic medical centers: implications for antimicrobial stewardship.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Ababneh, Mera Harpe, Spencer Oinonen, Michael Polk, Ron E.
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Ababneh M ( Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298, USA.)
Abstract	OBJECTIVE: To measure trends in aminoglycoside antibiotic use and gentamicin-resistant clinical isolates across a network of hospitals and compare network-level relationships with those of individual hospitals. DESIGN: Longitudinal observational investigation. SETTING: US academic medical centers. PARTICIPANTS: Adult inpatients. METHODS: Adult aminoglycoside use was measured from 2002 or 2003 through 2009 in 29 hospitals. Hospital-wide antibiograms assessed gentamicin resistance by proportions and incidence rates for Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Escherichia coli. Mixed-effects analysis of variance was used to assess the significance of changes in aminoglycoside use and changes in resistance rates and proportions. Generalized estimating equations were used to assess the relationship between aminoglycoside use and resistance. RESULTS: Mean aminoglycoside use declined by 41%, reflecting reduced gentamicin (P < .0001) and tobramycin (P < .005) use; amikacin use did not change. The rate and proportion of gentamicin-resistant P. aeruginosa decreased by 48% (P < .0001) and 31% (P < .0001), respectively. The rate and proportion of gentamicin-resistant E. coli increased by 166% and 124%, respectively (P < .0001), and they were related to increasing quinolone resistance in E. coli. Resistance among K. pneumoniae and A. baumannii did not change. Relationships between aminoglycoside use and resistance at the network level were highly variable at the individual hospital level. CONCLUSIONS: Mean aminoglycoside use declined in this network of US hospitals and was associated with significant and opposite changes in rates of resistance for some organisms and no change for others. At the individual hospital level, antibiograms appear to be an unreliable reflection of antibiotic use, at least for aminoglycosides.
File Format	HTM / HTML
ISSN	0899823X
Issue Number	6
Volume Number	33
e-ISSN	15596834
Journal	Infection Control & Hospital Epidemiology
Language	English
Publisher	Cambridge University Press
Publisher Date	2012-06-01
Publisher Place	United States
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Discipline Communicable Diseases Discipline Epidemiology Academic Medical Centers Trends Aminoglycosides Anti-bacterial Agents Drug Resistance, Bacterial Drug Utilization Acinetobacter Baumannii Drug Effects Isolation & Purification Adult Pharmacology Analysis Of Variance Databases, Factual Escherichia Coli Gentamicins Humans Klebsiella Pneumoniae Longitudinal Studies Microbial Sensitivity Tests Pseudomonas Aeruginosa United States Journal Article Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Epidemiology Microbiology (medical)

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