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Figure 3: Relationship between new acquisition andinfection rates to the overall burden of MRSA incontributing hospitals.Figure 5: New MRO acquisitions for all participatingcontributors, grouped by resistance category.This chart highlights the success of statewidesurveillance and quality improvement activities, sincethe overall infection rate continues to trend downwardsdespite a continuing high MRSA burden. It should benoted that both the burden and new acquisition rates aresensitive to the intensity of screening practices, whichhave increased in several hospitals over the period.*”Other” includes VRE vanA and vanB, carbapenemresistantEnterobacteriaceae or Acinetobacter species,and vancomycin intermediate Staphylococcus aureus.Figure 6: MRO acquisitions by specimen category.Figure 4: MRSA infection rates stratified by intensivecare units (ICU) and all clinical units combined.In 2005, for other MROs (excluding MRSA), urinecontinues to be the most common site of isolationfollowed by respiratory isolates (Figure 6).As Figure 4 illustrates, the rate of MRSA infectionis highest in those patients who are most at risk forinfection, i.e. intensive care unit patients.Other multi-resistant organismsDuring 2005 there were 120 new episodes of infectionor colonisation with multi-resistant organisms (MROs)other than MRSA reported. These were predominantlymulti-resistant Pseudomonas aeruginosa (MR-PAER) andextended spectrum beta-lactamase (ESBL) producingorganisms. Figures 5 and 6 present aggregate datafor the 15 contributing hospitals. The incident casesare presented rather than rates, because the overallnumbers are small.ANTIMICROBIAL UTILISATIONThe South Australian statewide antimicrobialutilisation program was established in November2001. The program collects in-hospital antimicrobialusage data from both metropolitan and countryhospitals. Currently 14 metropolitan hospitals, 7public and 7 private, are contributing to the program,the results of which are discussed below. Data fromNovember 2001 to November 2005 are reported. Theantimicrobial utilisation rates provided are calculatedusing the number of defined daily doses (DDDs) of theantimicrobial agent/class consumed per 1000 occupiedbed days (OBDs).Monthly analysis of aggregate data suggests an upwardtrend in total antimicrobial consumption (Figure 7).38
Figure 7: Total monthly aggregate antimicrobialusageFigure 10: Annual usage by class - ICUCorresponding aggregate usage rates for intensivecare units (ICU) suggest a downward trend (Figure8); however the considerable monthly fluctuations inantimicrobial usage in these units make assessment oftrends difficult. Analysis of usage within individual unitshas demonstrated a large variation in usage patterns.While statewide usage rates for some antimicrobialclasses appear to show no significant trend over thisperiod, increasing use of fluoroquinolones, in particularciprofloxacin, is evident for both total (Figure 11) and ICUusage (Figure 12).Figure 11: Total aggregate fluoroquinolone usageFigure 8: ICU monthly aggregate antimicrobial usage.Figure 12: ICU aggregate fluoroquinolone usageTotal aggregate annual usage rates by antimicrobial classare shown in Figure 9.Figure 9: Annual usage by class - total hospitalICU annual usage rates by antimicrobial class are shownin Figure 10.39In recent years, the emergence of a highly virulent formof Clostridium difficile, associated with high morbidityand mortality, has been reported in the USA and Canada,and has now also been documented in Europe. Diseaseassociated with this new strain has been shown tooccur with increased frequency and severity, and highrates of recurrence have also been noted. A clearassociation with the use of fluoroquinolones has beendemonstrated in outbreaks, with increased resistance tothese antimicrobials documented. 3
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