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Control of multiply resistant cocci: do international comparisons help?
S Harbarth1, W Albrich, D A Goldmann
1Children's Hospital, and Harvard Medical School, Boston, USA. stephan.harbarth@hcuge.ch
The Lancet. Infectious Diseases
|March 2, 2002
Summary
Antibiotic resistance varies significantly between the USA and Germany due to factors like prescribing practices and healthcare systems. Understanding these differences is key to controlling the spread of resistant bacteria globally.
Area of Science:
- Microbiology
- Epidemiology
- Public Health
Background:
- Antibiotic resistance is a global health crisis.
- Geographic variations in antibiotic-resistant microorganisms are not fully understood.
- Significant differences exist in the prevalence of multiresistant gram-positive cocci between the USA and Germany.
Purpose of the Study:
- To investigate the reasons behind the uneven geographic distribution of antibiotic resistance.
- To compare the epidemiology of specific multiresistant pathogens in the USA and Germany.
- To identify determinants influencing antibiotic resistance patterns.
Main Methods:
- Comparative analysis of epidemiological data from the USA and Germany.
- Review of factors including diagnostic practices, antibiotic prescribing, population characteristics, cultural factors, healthcare systems, and infection control.
- Literature review and synthesis of existing reports on antibiotic resistance.
Main Results:
- Prevalence rates for penicillin-resistant pneumococci (PRP), meticillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) are substantially higher in the USA compared to Germany.
- Key disparities include differences in diagnostic practices, antibiotic prescribing habits, population demographics (e.g., daycare exposure in the USA), and healthcare system factors.
- Specific pathogens like VRE show differences in clonal spread and transmissibility.
Conclusions:
- Multiple determinants contribute to the geographic variation in antibiotic resistance.
- Understanding these factors is crucial for developing targeted interventions to curb the spread of resistant bacteria.
- A macro-level perspective and rational surveillance strategies are needed globally to combat antibiotic resistance.