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Homogeneity of antimicrobial policy, yet heterogeneity of antimicrobial resistance: antimicrobial non-susceptibility among 108,717 clinical isolates from primary, secondary and tertiary care patients in London.

Moore LS, Freeman R, Gilchrist MJ, Gharbi M, Brannigan ET, Donaldson H, Livermore DM, Holmes AH - J. Antimicrob. Chemother. (2014)

Bottom Line: We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends.The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions.Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.

View Article: PubMed Central - PubMed

Affiliation: National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK.

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(a) Proportion of Pseudomonas spp. from clinical samples displaying ciprofloxacin non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (b) Proportion of Pseudomonas spp. from clinical samples displaying piperacillin/tazobactam non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (c) Proportion of Pseudomonas spp. from clinical samples displaying meropenem non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction.
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DKU307F2: (a) Proportion of Pseudomonas spp. from clinical samples displaying ciprofloxacin non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (b) Proportion of Pseudomonas spp. from clinical samples displaying piperacillin/tazobactam non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (c) Proportion of Pseudomonas spp. from clinical samples displaying meropenem non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction.

Mentions: A total of 12 616 Pseudomonas spp. were identified, 10 226 of them confirmed as P. aeruginosa (Table 2). Across both hospitals and the renal cohorts, Pseudomonas spp. comprised 75.3%–88.9% of all non-fermenters, with 63.0%–77.1% identified as P. aeruginosa. Non-susceptibility to ciprofloxacin (Figure 2a), piperacillin/tazobactam (Figure 2b) and meropenem (Figure 2c) was analysed.Figure 2.


Homogeneity of antimicrobial policy, yet heterogeneity of antimicrobial resistance: antimicrobial non-susceptibility among 108,717 clinical isolates from primary, secondary and tertiary care patients in London.

Moore LS, Freeman R, Gilchrist MJ, Gharbi M, Brannigan ET, Donaldson H, Livermore DM, Holmes AH - J. Antimicrob. Chemother. (2014)

(a) Proportion of Pseudomonas spp. from clinical samples displaying ciprofloxacin non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (b) Proportion of Pseudomonas spp. from clinical samples displaying piperacillin/tazobactam non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (c) Proportion of Pseudomonas spp. from clinical samples displaying meropenem non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction.
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4228780&req=5

DKU307F2: (a) Proportion of Pseudomonas spp. from clinical samples displaying ciprofloxacin non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (b) Proportion of Pseudomonas spp. from clinical samples displaying piperacillin/tazobactam non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction. (c) Proportion of Pseudomonas spp. from clinical samples displaying meropenem non-susceptibility among 12 616 isolates from primary, secondary and tertiary care patients in West London, 2009–13. Error bars indicate 95% CIs calculated by Wilson's method with continuity correction.
Mentions: A total of 12 616 Pseudomonas spp. were identified, 10 226 of them confirmed as P. aeruginosa (Table 2). Across both hospitals and the renal cohorts, Pseudomonas spp. comprised 75.3%–88.9% of all non-fermenters, with 63.0%–77.1% identified as P. aeruginosa. Non-susceptibility to ciprofloxacin (Figure 2a), piperacillin/tazobactam (Figure 2b) and meropenem (Figure 2c) was analysed.Figure 2.

Bottom Line: We found significant fluctuations in non-susceptibility year on year across the cohorts, but with few persistent trends.The marked heterogeneity of antimicrobial susceptibilities between hospitals, within hospitals and over time demands detailed, standardized surveillance and appropriate benchmarking to identify possible drivers and effective interventions.Homogeneous antimicrobial policies are unlikely to continue to be suitable as individual hospitals join hospital networks, and policies should be tailored to local resistance rates, at least at the hospital level, and possibly with finer resolution, particularly for critical care.

View Article: PubMed Central - PubMed

Affiliation: National Centre for Infection Prevention and Management, Imperial College London, Hammersmith Campus, Du Cane Road, London W12 0HS, UK Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK.

Show MeSH
Related in: MedlinePlus