Trends in Antibiotic Resistance in Coagulase-Negative Staphylococci, United States,

Transcription

1 Supplementary Information For Trends in Antibiotic Resistance in Coagulase-Negative Staphylococci, United States, Larissa May, a Eili Y. Klein, b,c# Richard E. Rothman, b Ramanan Laxminarayan c,d Department of Emergency Medicine, George Washington University, Washington, DC, USA a ; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA b ; Center for Disease Dynamics, Economics & Policy, Washington, DC c ; Princeton Environmental Institute, Princeton University, Princeton, NJ, USA d

2 Supplementary Table 1a: Staphylococcus epidermidis Resistance, by Drug and Age, Blood Isolates, Inpatients, United States, Multidrugresistant Ciprofloxacin Clindamycin Levofloxacin % ( ) 59.8% ( ) 60.2% ( ) 60.2% ( ) 61.8% ( ) 62.4% ( ) 63.1% ( ) 66.6% ( ) 65.3% ( ) 69.2% ( ) 68.8% ( ) 66.8% ( ) 65.3% ( ) 68.4% ( ) 43.4% ( ) 47.3% ( ) 48.5% ( ) 45.2% ( ) 45.6% ( ) 51.3% ( ) 51.7% ( ) 51.2% ( ) 50.7% ( ) 52.9% ( ) 55.5% ( ) 52.6% ( ) 50.4% ( ) 48.5% ( ) 57.1% ( ) 57.2% ( ) 59.7% ( ) 60.5% ( ) 62.9% ( ) 62.6% ( ) 78.6% ( ) 77.2% ( ) 75.0% ( ) 76.1% ( ) 72.3% ( ) 68.9% ( ) 66.8% ( ) 68.1% ( ) 33.6% ( ) 36.2% ( ) 35.9% ( ) 34.4% ( ) 35.6% ( ) 39.4% ( ) 56.3% ( ) 53.4% ( ) 53.6% ( ) 50.4% ( ) 44.5% ( ) 40.3% ( ) 38.8% ( ) 41.1% ( ) Multidrug-resistant is defined as isolates tested against ciprofloxacin, clindamycin, oxacillin, and levofloxacin in which the isolate was resistant to all four drugs.

3 Supplementary Table 1b: Staphylococcus epidermidis Resistance, by Drug and Age, Blood Isolates, Inpatients, United States, Multidrugresistant Ciprofloxacin Clindamycin Levofloxacin / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /649 Multidrug-resistant is defined as isolates tested against ciprofloxacin, clindamycin, oxacillin, and levofloxacin in which the isolate was resistant to all four drugs. Results are isolates found resistant or intermediately resistant divided by the total number of isolates tested

4 Supplementary Table 2a: Multidrug Resistance in Coagulase-Negative Staphylococcal Species All coagulase-negative Drug Staphylococcus species Staphylococcus epidermidis Staphylococcus hominis % ( ) 34.9% ( ) 34.1% ( ) 33.1% ( ) 31.4% ( ) 34.0% ( ) 45.3% ( ) 41.4% ( ) 38.9% ( ) 36.2% ( ) 30.2% ( ) 29.4% ( ) 27.7% ( ) 29.6% ( ) 34.7% ( ) 38.5% ( ) 36.8% ( ) 36.1% ( ) 36.4% ( ) 40.2% ( ) 54.4% ( ) 53.1% ( ) 51.9% ( ) 46.9% ( ) 40.8% ( ) 35.8% ( ) 35.5% ( ) 36.8% ( ) 21.2% ( ) 24.1% ( ) 32.3% ( ) 29.8% ( ) 26.7% ( ) 22.7% ( ) 36.2% ( ) 42.5% ( ) 36.5% ( ) 24.5% ( ) 19.3% ( ) 18.3% ( ) 15.3% ( ) 18.1% ( ) Multidrug resistant is defined as proportion of isolates tested against ciprofloxacin, clindamycin, oxacillin, and levofloxacin that were resistant to all four drugs.

5 Supplementary Table 2b: Multidrug Resistance in Coagulase-Negative Staphylococcal Species All coagulase-negative Drug Staphylococcus species Staphylococcus epidermidis Staphylococcus hominis / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / /177 Multidrug resistant is defined as proportion of isolates tested against ciprofloxacin, clindamycin, oxacillin, and levofloxacin that were resistant to all four drugs. Results are isolates found resistant or intermediately resistant divided by the total number of isolates tested

6 Supplementary Table 3: ARIMA Model Parameters and Diagnostic Statistics for Antibiotic Prescription Time Series Time Series ARIMA Parameters AIC Q-Statistic* Levofloxacin prescriptions arima(2,0,0) Levofloxacin-resistant Staphylococcus epidermidis Blood isolates Levofloxacin-resistant Staphylococcus epidermidis all isolates arima(1,0,0) arima(1,0,0) Ciprofloxacin prescriptions arima(0,1,0) Fluoroquinlone Prescriptions arima(0,2,0) p= p= p= p= p=0.69 Multidrug-resistant Staphylococcus epidermidis Blood isolates arima(0,1,0) p=0.56 Multidrug-resistant Staphylococcus epidermidis all isolates Ciprofloxacin-resistant Staphylococcus epidermidis Blood isolates Ciprofloxacin-resistant Staphylococcus epidermidis all isolates arima(0,0,1) arima(1,0,0) arima(1,0,0) p= p= p=0.77 * In the Box-Ljung white noise test, the null hypothesis is that data are random and uncorrelated; thus a high p-value for the Q-statistic means that we can reject the null hypothesis that the residuals are correlated. Prescription data source: IMS Xponent, January, 1999 December 2010, IMS Health Incorporated. All Rights Reserved. Resistance data source: The Surveillance Network (TSN) Database-USA (managed by Eurofins Medinet, Chantilly, Virginia).

7 Supplementary Figure 1: Percentage of Staphylococcus epidermidis Inpatient Bloodstream Isolates Resistant to Linezolid, Gray zone represents 95% confidence interval.

8 Supplementary Figure 2: Percentage of Staphylococcus epidermidis, Staphylococcus aureus, and Escherichia coli Inpatient Bloodstream Isolates Resistant to Levofloxacin, Gray zone represents 95% confidence interval.

9 Supplementary Figure 3: Outpatient prescriptions for Fluoroquinolones, Source: IMS Xponent, January, 1999 December 2010, IMS Health Incorporated. All Rights Reserved.

10 Supplementary Figure 4: Percentage of Staphylococcus epidermidis Inpatient Bloodstream Isolates Resistant to Levofloxacin, Ciprofloxacin, and Clindamycin The solid lines describe isolates classified as resistant, while the dashed lines describe the isolates classified as intermediately resistant. Between 2004 and 2005 the CLSI breakpoints for levofloxacin resistance were changed, the new resistance breakpoints encompassed the intermediate breakpoints from the prior years, so in the analysis in the paper we counted intermediate isolates as resistant. The breakpoints for other drugs did not change over this period.