Background: National surveillance is proposed to be part of a National Strategy to Combat Antibiotic Resistance (AR) in the U.; recent access of state-summary metrics around antibiotic use and antibiotic resistance allows an opportunity to evaluate variability in AR among healthcare-associated infections (HAIs) between U.S. states.
Methods: We utilized data from 2016 accessible in the CDCÕs AR Patient Safety Atlas to create state-level values for the no. of HAIs (CLABSI, CAUTI, SSI) by select AR reported to NHSN, prescribing rates of outpatient antibiotics by class, and % of hospitals having full antibiotic stewardship programs. Other available data included 2016 CDCÕs Healthcare-Associated Infections Progress Report and US Census Data. We correlated (PearsonÕs partial correlation coefficients) the state prevalence (% testing resistant) for multidrug-resistant P. aeruginosa (MDR-PA), extended-spectrum cephalosporin-resistant E. coli (ESC-E.coli), and methicillin-resistant S. aureus (MRSA) from HAIs with potential predictors; multivariate logistic regression was used to assess independence.
Results: States prevalence of HAI AR varied and was explained in part by no. of skilled nursing facility bed days for MRSA (P=.002), % of population black for MRSA (P<.001) and ESC-E. coli (P<.001), % of population > 65 for ESC-E. coli (P<.001) and MDR-PA (P<.001), and no. of LTACHs for MDR-PA (P=.01). After adjusting for these, rates of outpatient fluoroquinolone (FQ) and cephalosporin prescribing (Figure) were significant predictors of ESC-R E. coli HAIs (adjusted OR 1.02, P<.001 and 1.01, P<.001 respectively) and FQ rates for MRSA HAIs (aOR 1.01, P=.004); the MRSA correlation was slightly elevated in states with a higher population of African-Americans. Of note, % hospitals with inpatient stewardship did not explain geographic variability in any HAI AR studied.
Conclusion: Outpatient antibiotic prescribing rates can explain much of the state-to-state variability in studied HAI-related AR even after adjusting for differences in age and healthcare facility composition. Stewardship across the spectrum of healthcare delivery is likely needed to improve patient safety in acute care hospitals.