Spatiotemporal Trends in Tetracycline and Trimethoprim-Sulfamethoxazole Resistant S. aureus Among Veteran Outpatients in the Eastern United States

Miah Boyle; Margaret Carrel; Qianyi Shi; Shinya Hasegawa; Jacob Oleson; Michihiko Goto

doi:10.1017/S0950268826101216

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Spatiotemporal Trends in Tetracycline and Trimethoprim-Sulfamethoxazole Resistant S. aureus Among Veteran Outpatients in the Eastern United States

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Spatiotemporal Trends in Tetracycline and Trimethoprim-Sulfamethoxazole Resistant S. aureus Among Veteran Outpatients in the Eastern United States

Miah Boyle, Margaret Carrel, Qianyi Shi, Shinya Hasegawa, Jacob Oleson and Michihiko Goto

Epidemiology and infection, Vol.154, e31

2026

DOI: 10.1017/S0950268826101216

PMID: 41725411

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Abstract

This study examines spatiotemporal patterns of tetracycline- and trimethoprim–sulfamethoxazole (TMP–SMX)–resistant Staphylococcus aureus (S. aureus) among United States (US) Veterans Health Administration (VHA) outpatients. Prevalence of tetracycline and TMP–SMX resistance in methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) was calculated for 2010–2023. MRSA cases from 2018 to 2022 were aggregated to commuting zones (CZs) in the eastern US, and CZ-specific relative risks and temporal trends were estimated using a hierarchical Bayesian Poisson model with a spatiotemporal interaction term. Results indicated that resistance in MRSA increased by 16.4% for tetracycline and 9.3% for TMP–SMX, while MSSA resistance remained stable. High-risk CZs were limited (3% for tetracycline, 4% for TMP–SMX) and distributed across the eastern US, with notable within-state variation in risk and trend. Most CZs exhibited stationary trends, although distinct patterns in the rate and timing of changes in resistance were observed in CZ-specific plots. These evolving and geographically variable patterns of antimicrobial resistance at finer spatial scales highlight the need for local surveillance and outpatient antibiotic stewardship strategies that consider place-based

Staphylococcus aureus

MRSA

antimicrobial resistance

spatiotemporal trends

Bayesian modeling

veteran outpatients

Details

Title: Subtitle: Spatiotemporal Trends in Tetracycline and Trimethoprim-Sulfamethoxazole Resistant S. aureus Among Veteran Outpatients in the Eastern United States
Creators: Miah Boyle - University of Iowa
Margaret Carrel - University of Iowa
Qianyi Shi - University of Iowa
Shinya Hasegawa - University of Iowa
Jacob Oleson - University of Iowa
Michihiko Goto - University of Iowa
Resource Type: Journal article
Publication Details: Epidemiology and infection, Vol.154, e31
DOI: 10.1017/S0950268826101216
PMID: 41725411
NLM abbreviation: Epidemiol Infect
ISSN: 1469-4409
eISSN: 1469-4409
Publisher: CAMBRIDGE UNIV PRESS; CAMBRIDGE
Language: English
Electronic publication date: 02/23/2026
Date published: 2026
Academic Unit: Epidemiology; Biostatistics; School of Earth, Environment, and Sustainability; Otolaryngology; Internal Medicine
Record Identifier: 9985141920102771

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