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Creator
Marin L. Schweizer
Michael R. Eber
Ramanan Laxminarayan
Jon P. Furuno
Kyle J. Popovich
Bala Hota
Michael A. Rubin
Eli N. Perencevich
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Fighting Antibiotic Resistance
Marrying New Financial Incentives To Meeting Public Health Goals

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Creator
Aaron S. Kesselheim
Kevin Outterson
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 The Question

Creator
Eili Y Klein
Ramanan Laxminarayan
David L Smith
Lova Sun
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 Objective: Multidrug-resistant Enterobacteriaceae pose a serious infection control challenge and have emerged as a public health threat. We examined national trends in the proportion of Klebsiella pneumoniae isolates resistant to carbapenems (CRKP) and third-generation cephalosporins (G3CRKP).

Design and Setting: Retrospective analysis of approximately 500,000 K. pneumoniae isolates cultured between January 1999 and July 2010 at 287 clinical laboratories throughout the United States.

Creator
Nikolay P Braykov
Michael R Eber
Eili Y Kle
Daniel J Morgan
Ramanan Laxminarayan
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Therapeutic antibiotic use in humans is a significant driver of antibiotic resistance. The seasonal effect of antibiotic use on antibiotic resistance has been poorly quantified because of lack of large-scale, spatially disaggregated time-series data on antibiotic use and resistance.

Creator
Lova Sun
Eili Y Klein
Ramanan Laxminarayan
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“One-Size-Fits-All”?
Optimizing Treatment Duration for Bacterial Infections

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Creator
Patricia Geli
Ramanan Laxminarayan
Michael Dunne
David L. Smith
Keywords,

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Background

Knowledge of seasonal trends in hospital-associated infection incidence may improve surveillance and help guide the design and evaluation of infection prevention interventions. We estimated seasonal variation in the frequencies of inpatient bloodstream infections (BSIs) caused by common bacterial pathogens and examined associations of monthly BSI frequencies with ambient outdoor temperature, precipitation, and humidity levels.

Creator
Michael R. Eber
Michelle Shardell
Marin L. Schweizer
Ramanan Laxminarayan
Eli N. Perencevich
Keywords, ,

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We show that respiratory fluoroquinolone use is extremely seasonal and that fluoroquinolone use is strongly associated with influenza. In our time series model, instantaneous influenza activity was a significant predictor of use ([Formula: see text]). Also, we estimated that reducing influenza activity by 20% would reduce prescriptions by 8%.

Creator
Philip M. Polgreen
M. Yang
Ramanan Laxminarayan
J. E. Cavanaugh
Keywords,

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Sales for a drug may be correlated with the prevalence of a condition treated by the drug. We found that state data revealed a strong spatial association and national data a strong temporal association between Clostridium difficile and oral vancomycin prescription sales, suggesting a new “signal” for detecting disease activity.

Creator
Philip M. Polgreen
M. Yang
J. L. Kuntz
Ramanan Laxminarayan
J. E. Cavanaugh
Keywords,
Improving Antimicrobial Stewardship
The Evolution of Programmatic Strategies and Barriers

Objective: To describe the prevalence and characteristics of antimicrobial stewardship programs (ASPs) in hospitals across the United States and to describe financial support provided for these programs.

Design:  Electronic and paper 14-question survey of infectious diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN). Participants. All 1,044 IDSA EIN members who care for adult patients were invited to participate.

Creator
Birgir Johannsson
Susan E. Beekmann
Arjun Srinivasan
Adam L. Hersh
Ramanan Laxminarayan
Philip M. Polgreen
Keywords, , ,

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Health care–associated infections affect 1.7 million hospitalizations each year, but the clinical and economic costs attributable to these infections are poorly understood. Reliable estimates of these costs are needed to efficiently target limited resources for the greatest public health benefit.

Creator
Michael R. Eber, BSE
Ramanan Laxminarayan, PhD, MPH
Eli N. Perencevich, MD, MS
Anup Malani, PhD, JD
Keywords
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PDF

Acinetobacter is an increasingly important hospital‐associated pathogen. Multidrug resistance among Acinetobacter species continues to rise, and infection with these multidrug‐resistant organisms has a profound negative impact on patient outcomes. Carbapenem resistance is frequently used by hospitals as a definition for multidrug resistance among Acinetobacter species, because it is often associated with resistance to other antibiotic classes.

Creator
Marc S. Hoffmann, MD
Michael R. Eber, BSE
Ramanan Laxminarayan, PhD, MPH
Keywords
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Klein.CA-MRSA.pdf

In an analysis of more than 300 microbiology labs serving hospitals all over the United States, researchers found that the proportion of MRSA cases in outpatients nearly doubled between 1999 and 2006. The study found that much of the growing burden of MRSA was associated with a greater proportion of newer “community-associated” strains of MRSA, which rose in outpatient units from 3.6 percent to 28.2 percent—amounting to a seven-fold jump during the study period.

Creator
Eili Klein, David L. Smith, and Ramanan Laxminarayan
Keywords

Despite significant concern in the health care community regarding vancomycin-resistant enterococci (VRE), there are no estimates of the total number of VRE infections that occur each year in US hospitals. Using data from a national survey of hospital discharges and a national antimicrobial resistance surveillance system, we estimated the annual number of US hospitalization with VRE bloodstream, urinary tract, and wound or intra-abdominal infections.

Creator
Rebecca Reik
Fred C. Tenover
Eili Klein
L. Clifford McDonald
Keywords
Antibiotic Overuse
The Influence of Social Norms

The overprescription of antibiotics in the United States can be attributed to two main causes: maximization of individual benefit, and social norms that often defy rationality. Policy solutions to growing antimicrobial resistance aimed at changing behavior within the physician- patient dyad are largely ineffective, as neither party has a strong disincentive to prescribe or use these generally safe drugs, and present illness weighs far heavier than potential future resistance.

Creator
The McDonnell Norms Group
Ramanan Laxminarayan
Anup Malani et al.
Keywords