Translating Evidence Into Practice: The Importance of Continuing Local Bacterial Surveillance Even When National Data Are Available

Abstract

We decided to use only hospital data because prehospitalization data may be less reliable. However, data on residence in a nursing home is an exception, and we agree with Vandijck et al that it should have been included.When we repeated the calculations with the inclusion of nursing home residence as a covariate in the propensity score regression, the separation between patients with methicillinsusceptible S. aureus (MSSA) BSI and patients with MRSA BSI increased. According to the original calculations, there were 41 patients with a propensity score greater than 0.8; 2 of these patients developed a MSSA BSI, and 39 developed a MRSA BSI. When we applied the new regression, there were 47 patients with a propensity score greater than 0.8; 2 of these patients developed a MSSA BSI, and 45 developed a MRSA BSI. The effect of MRSA BSI on length of stay, cost after infection, and mortality became even less significant for the group of patients who had a propensity score greater than 0.1 and less than 0.8, while the effect of MRSA BSI on intensive care unit patients remained significant over the entire range of propensity scores. Previous antimicrobial therapy may also have an effect on clinical outcome and on hospital cost; however, these data were not available.

Antimicrobial resistance 1979–2009 at Karolinska hospital, Sweden: normalized resistance interpretation during a 30‐year follow‐up on Staphylococcus aureus and Escherichia coli resistance development

“…The selection of specimens did not give the correct denominator for an estimation of resistance levels in the population but gave a good picture of antimicrobial resistance in the patient material, which was the focus of the clinician for choice of therapy. Local surveillance thus served the local needs well but lent itself poorly to comparisons with results from other laboratories (37).…”