Stewardship Program Explores Antimicrobial Use, Resistance

The proportion of nosocomial bacteremia cases caused by methicillin-resistant Staphylococcus aureus declined from 20% to 10%, whereas rates for bacteremia caused by vancomycin-resistant enterococci held steady at about 7%.

It is possible that in some cases the replacement agents continued to foster resistance to the antibiotics the hospital had stopped using, Dr. Sarwari suggested. Although this theory to explain the findings is not new, future studies may be able to discern how the use of one antibiotic affects resistance to another drug or class of drugs.

In a separate poster presentation, Dr. Sarwari and his coinvestigators reported that antibiotic use and resistance rates in an ICU were similar to the results for the hospital as a whole.

Dr. Sarwari said he thinks that a program similar to WVU's could work well at small community-based hospitals, especially if they incorporated only the most important elements of the program.

The hospital's antimicrobial stewardship program "appears to be reasonably successful in affecting institutional use and resistance, but I'm not sure it has [had much] influence on the problem of imported resistance," Dr. Sarwari said.

In the future, "the big thing we want to try to introduce is some form of molecular microbiology to better get a sense of how many resistant bugs are new strains versus the same strains being passed around due to poor infection control."

Dr. Sarwari disclosed no conflicts of interest.