Effect of Antibiotic Stewardship Program Intensity and Outpatient Antibiotic Prescribing Rates on the Variability in Prevalence of Antibiotic-Resistant Phenotypes between U.S. States Open Access

Abstract

Antibiotic resistant bacteria are major causes of morbidity and mortality in the United States. Despite the presence of national recommendations to reduce the prevalence of antibiotic resistant bacteria, there is significant variability in resistance prevalence between U.S. states. The purpose of this study was to determine whether the variability in prevalence for multidrug-resistant (MDR) P. aeruginosa, extended-spectrum beta lactamase-producing (ESBL) E. coli, and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infection (HAI) prevalence between U.S. states can be explained by differences in the extent of hospital antibiotic stewardship programs and outpatient antibiotic prescribing rates. Multivariate logistic regression was used to build models for each antibiotic-resistant phenotype. Pearson’s partial correlation coefficients (R2) and respective p-values were calculated to determine direction and strength of correlations. Intensity of antibiotic stewardship did not explain the geographic variability in MDR P. aeruginosa, ESC-R E. coli, or MRSA prevalence. Outpatient fluoroquinolone and cephalosporin prescribing rates explained some of the geographic variability in ESC-R E. coli prevalence between U.S. states. Outpatient fluoroquinolone prescribing rate explained some of the geographic variability in MRSA prevalence; this correlation was slightly elevated in states with a higher population of African-Americans. Future research should focus on racial differences in antibiotic use or the temporal relationship between timing of antibiotic stewardship implementation and antibiotic-resistant prevalence.

Table of Contents

Chapter I: Background…………………………………………………………………………….1

Chapter II: Manuscript

Abstract……………………………………………………………………………………...............7

Introduction………………………………………………………………………………..............8

Methods…………………………………………………………………………………................10

Results……………………………………………………………………………………................13

Discussion………………………………………………………………………………................16

References………………………………………………………………………………................21

Tables……………………………………………………………………………………..................28

Figures…………………………………………………………………………………….................34

Chapter III: Public Health Implications…………………………………………………….35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	E. coli antibiotic prescribing Pseudomonas aeruginosa MRSA antibiotic resistance antibiotic stewardship
Committee Chair / Thesis Advisor	Fridkin, Scott, Emory University
Committee Members	Weiner, Lindsey, CDC
Partnering Agencies	CDC

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