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. 2014;58(3):1404-9.
doi: 10.1128/AAC.01908-13. Epub 2013 Dec 16.

Trends in antibiotic resistance in coagulase-negative staphylococci in the United States, 1999 to 2012

Larissa May  1 , Eili Y Klein, Richard E Rothman, Ramanan Laxminarayan
Affiliations

Trends in antibiotic resistance in coagulase-negative staphylococci in the United States, 1999 to 2012

Larissa May et al. Antimicrob Agents Chemother. 2014.

Abstract

Coagulase-negative staphylococci (CoNS) are important bloodstream pathogens that are typically resistant to multiple antibiotics. Despite the concern about increasing resistance, there have been no recent studies describing the national prevalence of CoNS pathogens. We used national resistance data over a period of 13 years (1999 to 2012) from The Surveillance Network (TSN) to determine the prevalence of and assess the trends in resistance for Staphylococcus epidermidis, the most common CoNS pathogen, and all other CoNS pathogens. Over the course of the study period, S. epidermidis resistance to ciprofloxacin and clindamycin increased steadily from 58.3% to 68.4% and from 43.4% to 48.5%, respectively. Resistance to levofloxacin increased rapidly from 57.1% in 1999 to a high of 78.6% in 2005, followed by a decrease to 68.1% in 2012. Multidrug resistance for CoNS followed a similar pattern, and this rise and small decline in resistance were found to be strongly correlated with levofloxacin prescribing patterns. The resistance patterns were similar for the aggregate of CoNS pathogens. The results from our study demonstrate that the antibiotic resistance in CoNS pathogens has increased significantly over the past 13 years. These results are important, as CoNS can serve as sentinels for monitoring resistance, and they play a role as reservoirs of resistance genes that can be transmitted to other pathogens. The link between the levofloxacin prescription rate and resistance levels suggests a critical role for reducing the inappropriate use of fluoroquinolones and other broad-spectrum antibiotics in health care settings and in the community to help curb the reservoir of resistance in these colonizing pathogens.

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Figures

FIG 1
FIG 1
Percentage of resistant Staphylococcus epidermidis bloodstream isolates from inpatients, 1999 to 2012. Multidrug resistance (MDR) is defined as resistance to levofloxacin, clindamycin, ciprofloxacin, and oxacillin. Gray zones represent 95% confidence intervals.
FIG 2
FIG 2
Percentage of all resistant coagulase-negative Staphylococcus sp. isolates from inpatients, 1999 to 2012. The CoNS species data include data for S. epidermidis and S. hominis. The data for these two species are included for comparison. Gray zones represent 95% confidence intervals.
FIG 3
FIG 3
Regional variations in coagulase-negative staphylococcal resistance. There were significant variations in the rates of resistance between regions for Staphylococcus epidermidis blood isolates from inpatients (A) and all coagulase-negative species from all sources (B). In particular, the Northeast had high rates of resistance.
FIG 4
FIG 4
Correlation between levofloxacin drug use and resistance. Levofloxacin drug use increased significantly between 1999 and 2005, corresponding to a period of rising resistance rates for S. epidermidis to levofloxacin. As the number of prescriptions fell over the next several years, resistance also fell, although it did not fall as fast or as far as it rose, and increases in the number of prescriptions in 2012 are associated with increases in resistance rates. (Drug usage source, IMS Xponent, January 1999 to December 2010, IMS Health Incorporated; resistance data source, The Surveillance Network.)
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