Gundersen Lutheran Medical Foundation
The Gundersen Medical Journal
Background: The Centers for Disease Control and Prevention advocate data collection and monitoring as one facet of a comprehensive approach to combat antimicrobial resistance in the United States. However, a paucity of such data exists at the local/state level for common disease-causing organisms.
Methods: To begin to characterize epidemiologic correlates of antibacterial resistance in Wisconsin, data analyses were performed with respect to isolates in the Surveillance of Wisconsin Organisms for Trends in Antimicrobial Resistance and Epidemiology (SWOTARE) 2016 collection. In addition to submitting isolates of Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, and Streptococcus pneumoniae, participating laboratories were also requested to submit data regarding patient age, specimen source, and location of patient service.
Results: Fifty-five percent of isolates were of outpatient origin (including emergency department). In general, isolates derived from inpatients were more likely to demonstrate higher resistance rates than those from outpatient locations. Upon further stratification, isolates from emergency department encounters generally exhibited higher susceptibility rates than those from outpatient clinics. Sixty-seven percent of isolates emanated from skin and soft tissue or invasive sites. Delineation of specimen source played a minimal role in prediction of antimicrobial resistance. Older patients were more likely to generate isolates of E coli and P mirabilis exhibiting resistance to agents such as fluoroquinolones and trimethoprim-sulfamethoxazole.
Conclusions: SWOTARE facilitates epidemiologic investigations into resistance at the local/ state level. Investigations are warranted to further delineate differences in isolates derived from emergency department and outpatient clinic visits. Characterizations at the demographic level could impact local empiric treatment guidelines and antimicrobial stewardship throughout Wisconsin.
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