Antimicrobial resistance in isolates from inpatients and outpatients in the United States: increasing importance of the intensive care unit.

To compare the occurrence of antimicrobial resistance in hospitals with that in the community, we analyzed data for isolates collected from inpatients and outpatients in eight U.S. hospitals. The percentage of resistant isolates from inpatients was higher than that from outpatients for the following combinations of antimicrobials and organisms: methicillin/coagulase-negative Staphylococcus (49.0% vs. 36.0%, respectively; P < .01); methicillin/Staphylococcus aureus (33.0% vs. 14.5%, respectively; P < .01); ceftazidime/Enterobacter cloacae (26.0% vs. 12.0%, respectively; P < .01); imipenem/Pseudomonas aeruginosa (12.0% vs. 6.5%, respectively; P < .01); ceftazidime/P. aeruginosa (7.8% vs. 4.0%, respectively; P < .01); and vancomycin/Enterococcus species (6.3% vs. 1.4%, respectively; P < .01). There was a significant stepwise decrease in the percentage of resistant organisms isolated from patients in the intensive care unit (ICU), non-ICU inpatients, and outpatients. These results suggest that resources allocated to control antimicrobial resistance should continue to be focused in the hospital, particularly in the ICU.

[1]  Bruce L. Miller,et al.  Office of Technology Assessment Task Force , 1991 .

[2]  E. Bryce,et al.  Focused microbiological surveillance and gram-negative beta-lactamase--mediated resistance in an intensive care unit. , 1995 .

[3]  M. Cetron,et al.  The prevalence of drug-resistant Streptococcus pneumoniae in Atlanta. , 1995, The New England journal of medicine.

[4]  E. Bryce,et al.  Focused Microbiological Surveillance and Gram-Negative Beta-Lactamase-Mediated Resistance in an Intensive Care Unit , 1995, Infection Control &#x0026; Hospital Epidemiology.

[5]  T. Frieden,et al.  Emergence of vancomycin-resistant enterococci in New York City , 1993, The Lancet.

[6]  R. Weinstein,et al.  Strategies for prevention and control of multiple drug-resistant nosocomial infection. , 1981, The American journal of medicine.

[7]  J. Mcgowan,et al.  Antimicrobial susceptibility in gram-negative bacteremia: are nosocomial isolates really more resistant? , 1989, Antimicrobial Agents and Chemotherapy.

[8]  T. Merigan,et al.  Patient factors contributing to the emergence of gentamicin-resistant Serratia marcescens. , 1979, The American journal of medicine.

[9]  F. Tenover,et al.  Emergence of drug-resistant pneumococcal infections in the United States. , 1994, JAMA.

[10]  W. Hierholzer,et al.  The Evolving Epidemiology of Methicillin-Resistant Staphylococcus aureus at a University Hospital , 1995, Infection Control &#x0026; Hospital Epidemiology.

[11]  W J Martone,et al.  National nosocomial infections surveillance system (NNIS): description of surveillance methods. , 1991, American journal of infection control.

[12]  R. Gaynes,et al.  Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. , 1991, The American journal of medicine.

[13]  J W Hoyt,et al.  High risk of hospital‐acquired infection in the ICU patient , 1982, Critical care medicine.