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Trends in Aminoglycoside Use and Gentamicin-Resistant Gram-Negative Clinical Isolates in US Academic Medical Centers: Implications for Antimicrobial Stewardship

Published online by Cambridge University Press:  02 January 2015

Mera Ababneh ,
Spencer Harpe ,
Michael Oinonen  and
Ron E. Polk
Mera Ababneh
Affiliation:
Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
Spencer Harpe
Affiliation:
Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia Department of Epidemiology and Community Health, School of Medicine, Virginia Commonwealth University, Richmond, Virginia
Michael Oinonen
Affiliation:
University HealthSystem Consortium, Chicago, Illinois
Ron E. Polk*
Affiliation:
Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, Virginia
*
VCU School of Pharmacy/MCV Campus, 410 North 12th Street, PO Box 980533, Richmond, VA 23298 (rpolk@vcu.edu)
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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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 6 , June 2012 , pp. 594 - 601
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012 

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