A Study of Rural Hospital Antimicrobial Resistance Proficiency

Publication Date


Type of Culminating Activity


Degree Title

Master of Health Science in Supervisory Leadership

Major Advisor

Sarah E. Toevs


Conrad Colby


Kurt B. Stevenson


The ability of hospital laboratories to detect antimicrobial resistance plays a major role in the treatment of bacterial infections by physicians and the outcomes of their patients. In June of 2002 rural hospital laboratories from Idaho and Utah were surveyed concerning their ability to detect antimicrobial resistance. Of the 41 hospitals that returned completed surveys, 28 (68%) performed onsite laboratory identification and susceptibilities on bacterial organisms. Each rural hospital received five bacterial organism: An imipenem-resistant Serratia marcescens, an oxacillin-resistant Staphylococcus aureus, a vancomycin-resistant Enterococcus faecalis, a vancomycin­ resistant Staphylococcus epidermidis, and an extended-spectrum beta-lactamase Klebsiella pneumonia. The reported findings were then scored through reference results and grading criteria provided by the Centers for Disease Control and Prevention.

The results demonstrated that the rural hospital laboratories scored lower on all five organisms than hospitals in urban settings with greater access to additional educational sources (Hageman, Fridkin, Mohammed, Steward, Gaynes, & Tenover, 2003). The accuracy testing rate for Staphylococcus epidermidis was 74% and 57% for Enterococcus faecalis. Of the 26 hospital laboratories that utilized the antimicrobial oxacillin for testing Staphylococcus aureus, five (19%) accurately reported results. Of the 28 hospital laboratories that reported results for Serratia marcescens, 12 failed to test against the antimicrobial agent imipenem equating a testing failure rate of 57%. Although 21 of the 28 (75%) hospital laboratories utilized an extended-spectrum cephalosporin or aztreonam only six of these hospitals indicated the presence of an extended-spectrum beta-lactamase Klebsiella pneumonia.

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