Homogeneity of antimicrobial policy, yet heterogeneity of antimicrobial resistance: antimicrobial non-susceptibility among 108717 clinical isolates from primary, secondary and tertiary care patients in London.
Author(s)
Type
Journal Article
Abstract
Objectives We examined the 4 year trend in antimicrobial susceptibilities and prescribing across levels of care at two London teaching hospitals and their multisite renal unit, and for the surrounding community.
Methods Laboratory and pharmacy information management systems were interrogated, with antimicrobial use and susceptibilities analysed between hospitals, within hospitals and over time.
Results A total of 108 717 isolates from 71 687 patients were identified, with significant differences (at P < 0.05) in antimicrobial susceptibility between and within hospitals. Across the 4 years, rates of ESBL-/AmpC-producing Enterobacteriaceae ranged from 6.4% to 10.7% among community isolates, 17.8% to 26.9% at ward level and 25.2% to 52.5% in critical care. Significant variations were also demonstrated in glycopeptide-resistant enterococci (ward level 6.2%–17.4%; critical care 21.9%–56.3%), MRSA (ward level 18.5%–38.2%; critical care 12.5%–47.9%) and carbapenem-resistant Pseudomonas spp. (ward level 8.3%–16.9%; critical care 19.9%–53.7%). Few instances of persistently higher resistance were seen between the hospitals in equivalent cohorts, despite persistently higher antimicrobial use in Hospital 1 than Hospital 2. We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends.
Conclusions The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions. Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.
Methods Laboratory and pharmacy information management systems were interrogated, with antimicrobial use and susceptibilities analysed between hospitals, within hospitals and over time.
Results A total of 108 717 isolates from 71 687 patients were identified, with significant differences (at P < 0.05) in antimicrobial susceptibility between and within hospitals. Across the 4 years, rates of ESBL-/AmpC-producing Enterobacteriaceae ranged from 6.4% to 10.7% among community isolates, 17.8% to 26.9% at ward level and 25.2% to 52.5% in critical care. Significant variations were also demonstrated in glycopeptide-resistant enterococci (ward level 6.2%–17.4%; critical care 21.9%–56.3%), MRSA (ward level 18.5%–38.2%; critical care 12.5%–47.9%) and carbapenem-resistant Pseudomonas spp. (ward level 8.3%–16.9%; critical care 19.9%–53.7%). Few instances of persistently higher resistance were seen between the hospitals in equivalent cohorts, despite persistently higher antimicrobial use in Hospital 1 than Hospital 2. We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends.
Conclusions The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions. Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.
Date Issued
2014-08-12
Date Acceptance
2014-07-17
Citation
Journal of Antimicrobial Chemotherapy, 2014, 69 (12), pp.3409-3422
ISSN
1460-2091
Publisher
Oxford University Press
Start Page
3409
End Page
3422
Journal / Book Title
Journal of Antimicrobial Chemotherapy
Volume
69
Issue
12
Copyright Statement
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Medical Research Council (MRC)
Imperial College Healthcare NHS Trust- BRC Funding
National Institute of Health Research Imperial Biomedical Research Centre
Grant Number
G0800777
RDA02 79560
WMNF_P46472
Subjects
Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Pharmacology & Pharmacy
antibiograms
healthcare-associated infections
multidrug-resistant organisms
antimicrobial stewardship
SELECTIVE DECONTAMINATION
BACTERIAL-COLONIZATION
HOSPITAL-WIDE
UNIT
ANTIBIOGRAMS
PNEUMONIA
DIVERSITY
UK
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents
Bacteria
Bacterial Infections
Cohort Studies
Drug Resistance, Bacterial
Drug Therapy
Female
Health Policy
Hospitals, Teaching
Humans
London
Male
Middle Aged
Primary Health Care
Secondary Care
Tertiary Healthcare
Young Adult
1115 Pharmacology And Pharmaceutical Sciences
0605 Microbiology
1108 Medical Microbiology
Publication Status
Published