Variation in facility-level likelihood of drug-resistant Staphylococcus aureus in outpatients remains after patient-level risk adjustment

Margaret Carrel; Qianyi Shi; Shinya Hasegawa; Christine Bricker; Miah Boyle; Michihiko Goto

doi:10.1017/ash.2025.10127

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Variation in facility-level likelihood of drug-resistant Staphylococcus aureus in outpatients remains after patient-level risk adjustment

Journal article

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Variation in facility-level likelihood of drug-resistant Staphylococcus aureus in outpatients remains after patient-level risk adjustment

Margaret Carrel, Qianyi Shi, Shinya Hasegawa, Christine Bricker, Miah Boyle and Michihiko Goto

Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.5(1), e205

09/10/2025

DOI: 10.1017/ash.2025.10127

PMCID: PMC12451804

PMID: 40989654

Appears in UI Libraries Support Open Access

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Abstract

Objective:Effective empiric therapy options for Staphylococcus aureus infections are limited by rising rates of resistance to non-beta lactam antimicrobial agents. The use of cumulative susceptibility testing results, antibiograms, are promoted as a tool for improving empiric therapy decisions, but it is unclear how much of the variation in antibiograms between facilities and the associated efficacy of antimicrobial agents is driven by underlying differences in patient characteristics such as comorbidities and prior antibiotic exposure.Design:Retrospective cohort study of 46,866 S. aureus specimens from outpatient settings of the Veterans Health Administration (VHA) from 2021 and 2022 linked to electronic health record information on patient comorbidities, prior antibiotic usage, age and gender.Setting:Outpatient VHA clinics in the conterminous 48 states plus Washington, DC.Methods:Hierarchical logistic regression of resistance outcomes among S. aureus specimens to determine how much variation in the likelihood of resistance to five commonly used classes of antibiotics existed after accounting for patient-level characteristics.Results:The likelihood of drug resistance significantly varies across the VHA’s outpatient facilities, over and above the patient case mixture seen at each facility. In particular, VHA facilities in the US South and West regions have high likelihood of antibiotic resistance after accounting for patient factors.Conclusions:Suggest that community-level population or environmental characteristics are thus also associated with the likelihood of antimicrobial resistance in S. aureus. Integration of statistical and spatial analysis of antibiotic susceptibility testing results can help identify places with higher risk of drug-resistance, and thus populations facing limited treatment options, to ensure antibiotic stewardship or other policies have the greatest positive impact.

Antibiotics

Antimicrobial Agents

Drug Resistance

Electronic Health Records

Health Care

Veterans

Antibiotic resistance

Gender

Health facilities

Patients

Spatial analysis

Staphylococcus infections

Surveillance

UIOWA OA Agreement

Details

Title: Subtitle: Variation in facility-level likelihood of drug-resistant Staphylococcus aureus in outpatients remains after patient-level risk adjustment
Creators: Margaret Carrel - University of Iowa
Qianyi Shi - University of Iowa
Shinya Hasegawa - University of Iowa
Christine Bricker - University of Iowa
Miah Boyle - University of Iowa
Michihiko Goto - University of Iowa
Resource Type: Journal article
Publication Details: Antimicrobial stewardship & healthcare epidemiology : ASHE, Vol.5(1), e205
DOI: 10.1017/ash.2025.10127
PMID: 40989654
PMCID: PMC12451804
NLM abbreviation: Antimicrob Steward Healthc Epidemiol
ISSN: 2732-494X
eISSN: 2732-494X
Publisher: Cambridge University Press; CAMBRIDGE
Grant note: Centers for Disease Control and Prevention Epicenter program award: CK000613 Agency for Healthcare Research and Quality: K08HS027472
The work was supported by the Centers for Disease Control and Prevention Epicenter program award CK000613 (MC, QS and CB) and the Agency for Healthcare Research and Quality under award number K08HS027472 (MG). MB and SH report no relevant funding sources. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Centers for Disease Control and Prevent, the Department of Veterans Affairs or the United States Government. The funders have no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
Language: English
Date published: 09/10/2025
Academic Unit: Epidemiology; Political Science; Internal Medicine
Record Identifier: 9984962538902771

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