Temporal Changes in Prevalence of Antimicrobial Resistance in 23 U.S. Hospitals

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.

Keywords

• antibiotic resistance
• epidemiologic methods
• nosocomial infections
• surveillance
• United States