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Is Antimicrobial Resistance a Bigger Problem in Tertiary Care Hospitals than in Small Community Hospitals in the United States?

The Question

CDDEP researchers find that rates of antimicrobial resistance (AMR) are similar between large tertiary care hospitals and small community hospitals, in a study published in Clinical Infectious Diseases.

This runs contrary to the widely held assumption that rates of AMR would be higher in tertiary care hospitals (TCHs) than small community hospitals (SCHs), because they typically treat more severe and complex illnesses with greater risk of resistant infection.

What we found

Using a national antimicrobial susceptibility database, researchers compared annual and aggregated rates of AMR in community and tertiary care hospitals from 1999 to 2012 for multidrug-resistant Escherichia coliStaphylococcus aureusKlebsiella pneumoniaeAcinetobacter baumannii, and Pseudomonas aeruginosa.

The study’s findings suggest that there was no significant overall variation in rates of AMR between TCHs and SCHs. While in inpatient settings, S. aureus, K. pneumoniae, A. baumannii were higher in SCHs, and S. aureus and P. aeruginosa were higher in TCH outpatient settings, after accounting for time trends and hospital-level variability, no significant variation had occurred.

Increasing trends among all pathogens, particularly E. coli, indicate a continued need to improve infection control and antimicrobial stewardship in all settings. A clear increasing trend of AMR in both settings and all pathogens was further confirmation of a growing national problem.

Why it matters

Understanding the dynamics of antimicrobial resistance within specific contexts is essential for developing effective strategies to prevent increasing AMR and preserve the effectiveness of lifesaving antibiotics. According to CDDEP scholar and study author Dr. Sumanth Gandra, “It is the lack of overall difference in resistance rates between SCHs and TCHs that suggests the need for improvement in infection control activities and antimicrobial stewardship programs in SCHs.”