Carbapenem-resistant Enterobacteriaceae and the correlation between carbapenem and fluoroquinolone usage and resistance in the US military health system

Emil P. Lesho; Robert J. Clifford; Uzo Chukwuma; Yoon I. Kwak; Mark Maneval; Charlotte Neumann; Suji Xie; Lindsey E. Nielsen; Michael D. Julius; Patrick McGann; Paige E. Waterman

doi:10.1016/j.diagmicrobio.2014.09.017

Carbapenem-resistant Enterobacteriaceae and the correlation between carbapenem and fluoroquinolone usage and resistance in the US military health system

Emil P. Lesho^*, Robert J. Clifford, Uzo Chukwuma, Yoon I. Kwak, Mark Maneval, Charlotte Neumann, Suji Xie, Lindsey E. Nielsen, Michael D. Julius, Patrick McGann, Paige E. Waterman

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Whether carbapenem or fluoroquinolone usage is correlated with carbapenem-resistant Enterobacteriaceae (CRE) has not been investigated at the level of an entire US nationwide managed health care system. We analyzed 75 million person-years of surveillance and 1,969,315 cultures from all 266 hospitals in the geographically dispersed US military health system. Incidences of CRE remained under 1 case per 100,000 person-years. Incidences of CRE increased relative to 2005 baseline levels in 3 of 7 subsequent years, then decreased in 2012 (P< 0.05). Incident proportions of carbapenem resistance (CR) differed significantly among years, geographical regions, and bacterial species. Although use and resistance strongly correlated (R> 0.80) for several "drug-bug" combinations, none were significant at the national or facility level. One exception was that inpatient consumption of fluoroquinolones was significantly correlated (P= 0.0007) with CR in Escherichia coli when data from the major referral centers of the Southern and Northern regions were combined.

Original language	English
Pages (from-to)	119-125
Number of pages	7
Journal	Diagnostic Microbiology and Infectious Disease
Volume	81
Issue number	2
DOIs	https://doi.org/10.1016/j.diagmicrobio.2014.09.017
State	Published - 2015
Externally published	Yes

Keywords

Antibiotic consumption
Antibiotic use
Carbapenem resistance
Healthcare network

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10.1016/j.diagmicrobio.2014.09.017

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Lesho, E. P., Clifford, R. J., Chukwuma, U., Kwak, Y. I., Maneval, M., Neumann, C., Xie, S., Nielsen, L. E., Julius, M. D., McGann, P., & Waterman, P. E. (2015). Carbapenem-resistant Enterobacteriaceae and the correlation between carbapenem and fluoroquinolone usage and resistance in the US military health system. Diagnostic Microbiology and Infectious Disease, 81(2), 119-125. https://doi.org/10.1016/j.diagmicrobio.2014.09.017

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abstract = "Whether carbapenem or fluoroquinolone usage is correlated with carbapenem-resistant Enterobacteriaceae (CRE) has not been investigated at the level of an entire US nationwide managed health care system. We analyzed 75 million person-years of surveillance and 1,969,315 cultures from all 266 hospitals in the geographically dispersed US military health system. Incidences of CRE remained under 1 case per 100,000 person-years. Incidences of CRE increased relative to 2005 baseline levels in 3 of 7 subsequent years, then decreased in 2012 (P< 0.05). Incident proportions of carbapenem resistance (CR) differed significantly among years, geographical regions, and bacterial species. Although use and resistance strongly correlated (R> 0.80) for several {"}drug-bug{"} combinations, none were significant at the national or facility level. One exception was that inpatient consumption of fluoroquinolones was significantly correlated (P= 0.0007) with CR in Escherichia coli when data from the major referral centers of the Southern and Northern regions were combined.",

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author = "Lesho, {Emil P.} and Clifford, {Robert J.} and Uzo Chukwuma and Kwak, {Yoon I.} and Mark Maneval and Charlotte Neumann and Suji Xie and Nielsen, {Lindsey E.} and Julius, {Michael D.} and Patrick McGann and Waterman, {Paige E.}",

note = "Funding Information: Funding: This work was supported by the US Army Medical Command and the Armed Forces Health Surveillance Center-Global Emerging Infections Surveillance and Response System, who had no role in the collection or analysis of data, nor the preparation of the manuscript. ",

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Lesho, EP, Clifford, RJ, Chukwuma, U, Kwak, YI, Maneval, M, Neumann, C, Xie, S, Nielsen, LE, Julius, MD, McGann, P & Waterman, PE 2015, 'Carbapenem-resistant Enterobacteriaceae and the correlation between carbapenem and fluoroquinolone usage and resistance in the US military health system', Diagnostic Microbiology and Infectious Disease, vol. 81, no. 2, pp. 119-125. https://doi.org/10.1016/j.diagmicrobio.2014.09.017

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AU - Kwak, Yoon I.

AU - Maneval, Mark

AU - Neumann, Charlotte

AU - Xie, Suji

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AU - Julius, Michael D.

AU - McGann, Patrick

AU - Waterman, Paige E.

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AB - Whether carbapenem or fluoroquinolone usage is correlated with carbapenem-resistant Enterobacteriaceae (CRE) has not been investigated at the level of an entire US nationwide managed health care system. We analyzed 75 million person-years of surveillance and 1,969,315 cultures from all 266 hospitals in the geographically dispersed US military health system. Incidences of CRE remained under 1 case per 100,000 person-years. Incidences of CRE increased relative to 2005 baseline levels in 3 of 7 subsequent years, then decreased in 2012 (P< 0.05). Incident proportions of carbapenem resistance (CR) differed significantly among years, geographical regions, and bacterial species. Although use and resistance strongly correlated (R> 0.80) for several "drug-bug" combinations, none were significant at the national or facility level. One exception was that inpatient consumption of fluoroquinolones was significantly correlated (P= 0.0007) with CR in Escherichia coli when data from the major referral centers of the Southern and Northern regions were combined.

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ER -

Carbapenem-resistant Enterobacteriaceae and the correlation between carbapenem and fluoroquinolone usage and resistance in the US military health system

Abstract

Keywords

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