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. 2013 Dec 17:72:22297.
doi: 10.3402/ijch.v72i0.22297. eCollection 2013.

Streptococcus pneumoniae non-susceptibility and outpatient antimicrobial prescribing rates at the Alaska Native Medical Center

Ryan W Stevens  1 , Jay Wenger  2 , Lisa Bulkow  2 , Michael G Bruce  2
Affiliations

Streptococcus pneumoniae non-susceptibility and outpatient antimicrobial prescribing rates at the Alaska Native Medical Center

Ryan W Stevens et al. Int J Circumpolar Health. .

Abstract

Background: American Indian/Alaska Native (AI/AN) people suffer substantially higher rates of invasive pneumococcal disease (IPD) than the general US population. We evaluated antimicrobial prescribing data and their association with non-susceptibility in Streptococcus pneumoniae causing IPD in AI/AN people between 1992 and 2009.

Methods: Antimicrobial use data were gathered from the electronic patient management system and included all prescriptions dispensed to Alaska Native patients aged 5 years and older from outpatient pharmacies at the Alaska Native Medical Center (ANMC). Antimicrobial susceptibility data were gathered from pneumococcal isolates causing IPD among Anchorage Service Unit AI/AN residents aged 5 years and older. Data were restricted to serotypes not contained in the pneumococcal vaccine (PCV7).

Results: Over the study period, overall antimicrobial prescribing increased 59% (285/1,000 persons/year in 1992 to 454/1,000 persons per year in 2009, p<0.001). Trimethoprim/sulfamethoxazole prescribing increased (43/1,000 persons/year in 1992 to 108/1,000 persons/year in 2009, p<0.001) and non-susceptibility to trimethoprim/sulfamethoxazole in AI/AN patients ≥5 years of age increased in non-PCV7 serotypes (0-12%, p<0.05). Similarly, prescribing rates increased for macrolide antibiotics (46/1,000 persons/year in 1992 to 84/1,000 persons/year in 2009, p<0.05). We observed no statistically significant change over time in erythromycin non-susceptibility among non-PCV7 serotypes in AI/AN patients aged 5 years or greater (0-7%, p=0.087).

Conclusion: Antimicrobial prescribing patterns of some antibiotics in the AI/AN population corresponded to increased antimicrobial resistance in clinical isolates. This study highlights the on-going threat of antimicrobial resistance, the critical importance of judicious prescribing of antibiotics and the potential utility of prescribing data for addressing this issue.

Keywords: Alaska; Alaska Natives; Streptococcus pneumoniae; antibiotic prescribing; antibiotic resistance; invasive pneumococcal disease; susceptibility.

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Figures

Fig. 1
Fig. 1
Total antibiotic usage (Ceph+PCN+TET+macrolides+TMP/SMX) American Indian/Alaska Native persons ≥5 years of age (1992–2009).
Fig. 2
Fig. 2
Trimethoprim/sulfamethoxazole prescription rate per 1,000 American Indian/Alaska Native persons ≥5 years of age (1992–2009).
Fig. 3
Fig. 3
TMP/SMX non-susceptibility in IPD isolates (non-PCV7 serotypes) from patients ≥5 years of age (1992–2009).
Fig. 4
Fig. 4
Macrolide prescription rate per 1,000 American Indian/Alaska Native persons ≥5 years of age (1992–2009).
Fig. 5
Fig. 5
Erythromycin non-susceptibility in IPD isolates (non-PCV7 serotypes) from patients ≥5 years of age (1992–2009).
See this image and copyright information in PMC

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