Antibiotic Resistance Rates of Methicillin-Resistant Staphlococcus Aureus and Vancomycin-Resistant Enterococcus in Idaho Hospitals from 1994 to 1998

Publication Date

5-2000

Type of Culminating Activity

Thesis

Degree Title

Master of Science in Health Science, Health Policy

Supervisory Committee Chair

James Taylor

Supervisory Committee Member

Russell Centanni

Supervisory Committee Member

Christine Hahn

Abstract

Statewide drug-resistance rates of methicillan-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) within Idaho's hospitals are not well known by many health care providers or by Idaho's public health officials. Infections due to these pathogenic microorganisms have lead to increasing rates of morbidity and mortality nationally, and also to increasing costs of treatment. Antibiotics such as methicillin and vancomycin have been routinely used in health care facilities to fight serious infections caused by these and other microorganisms. But more and more microorganisms are developing resistance to the antibiotics used to fight deadly infections.

Surveys were sent to infection control practitioners at hospitals throughout Idaho. This thesis attempted to determine antibiotic-resistance rates within the general, acute-care hospitals throughout the state of Idaho. The paper compared the resistance rates in three regions of the state and attempted to compare rates occurring in larger hospitals to those of smaller hospitals. It was found that antibiotic-resistance rates and even incidence rates were not well documented in many hospitals.

Data from small hospitals regarding resistance rates was minimal, incomplete, and inconsistent. Without significant data from small hospitals, comparisons of large versus small hospital rates were not possible. The loosely structured telephone interviews of infection control practitioners from larger hospitals (greater than 100 beds) did provide meaningful data that allowed some comparison of resistance rates among areas of the state.

It was found that hospitals in the southwest part of the state have a higher antibiotic-resistance rate than those of the north or eastern sections. The rates reported in southwest Idaho, though highest in the state, were lower than rates in large cities in the eastern U.S.A. Treatments of Idaho residents outside of the state, caused by patient self-selection of providers and referrals to larger medical centers, may have caused a significant under-reporting of resistance rates in northern and eastern Idaho.

It was found that many hospitals do not know their drug-resistance rates. More small hospitals than large were unaware of the rates at their hospital. Smaller hospitals tend to have more primitive surveillance systems in this regard. The drug-resistance rates for MRSA that were reported by the various hospitals varied from a low of 3.6% in 1996 to a high of 21% in another surveyed hospital in 1998. The drug-resistance rates reported for infections caused by VRE varied from a low of zero to a high of 5%. Of those responding to the survey, 84% reported at least one case of MRSA and 58% reported at least one case of VRE.

It was also found that many of the large, and most of the small, hospitals did not have efficient data management systems that allowed Infection Control Practitioners (ICP) to adequately monitor or document resistance rates. Some ICP did not adequately monitor occurrences of drug-resistant microorganisms, yet made assumptions about incidence rates. These assumptions regarding low rates of incidence due to drug-resistant microorganisms could have caused some patients to be treated with less effective antibiotic protocols and this could have led to increased rates of morbidity or mortality.

Many hospitals within the state displayed a need to upgrade and improve their information processing systems so that greater knowledge of incidence rates and resistance rates could be obtained. This information would have allowed health care providers to treat patients with more advanced or effective antibiotic protocols. Utilization of improved treatment protocols in the future could protect against increases in morbidity and mortality associated with emerging forms of microbial pathogens.

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