Sarah Goodwin

Kathi Ovnic
Holly Korschun
June 18, 1998

Emory University and Centers for Disease Control and Prevention (CDC) epidemiologists have cited new data indicating that the spread of at least some antibiotic-resistant organisms may be linked to geographic areas as well as to individual health care systems.

In a study presented at the American Society of Microbiology (ASM) meeting held recently in Atlanta, John E. McGowan, Jr., professor of epidemiology at Emory's Rollins School of Public Health, and his CDC colleagues collected data on the bacterium Enterococcus, a common hospital infection that is increasingly resistant to all antimicrobials, including vancomycin, one of the last antimicrobials to effectively combat the more resistant bacteria.

In data collected from 20 U.S. hospitals in 13 states, the researchers found that the spread of individual clonal strains of vancomycin-resistant Enterococcus was correlated more directly with geographic location (including cities, states, and broad geographic areas) than with individual hospitals, hospitals of particular sizes, or different types of hospital (VA, teaching, or private).

The particular strains of Enterococcus the researchers studied, E. faecium and E. facculis, were found significantly more often in the Midwest and Northeast than in the Southeast, even considering other variables.

"These results suggest that instead of just focusing on the spread of vancomycin-resistant Enterococci within a particular institution or institutions, future research should investigate area-wide variations," said Dr. McGowan.

Vancomycin-resistant enterococci live in the gastrointestinal tract, and are responsible for urinary tract infections, and occasionally for bacterimia (blood infection) and endocarditis (infection of the heart).

The current research was part of Project ICARE, a joint study between Emory University's Rollins School of Public Health and the CDC to collect, analyze and rapidly report information about national patterns of antibiotic use and resistance in hospital intensive care units. In addition to Dr. McGowan, the study is headed by co-principal investigators Robert Gaynes, M.D., director of CDC's National Nosocomial Infections Surveillance System and adjunct associate professor at Emory, and Fred Tenover, Ph.D., head of CDC's Nosocomial Pathology Laboratory Branch and adjunct professor at Emory.

One goal of the study is to develop and improve mechanisms for surveillance, reporting and analysis of data on antibiotic resistance. The results can then be used to offer advice to hospitals and generate data to spark future research.

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