Antimicrobial resistance in 11 hospitals in Puerto Rico: results of an antimicrobial resistance management (ARM) program.

PURPOSE The Antimicrobial Resistance Management Program (ARMP) was established in 1997 at the University of Florida as an ongoing project to document trends in antimicrobial susceptibility patterns in inpatient/outpatient isolates and track resistance that may occur with specific antibiotic use. METHODS Institutions are enrolled at no charge and provide a minimum of 3 years of antibiogram/sensitivity report data, which are reviewed to create a customized analysis of antimicrobial susceptibility trends benchmarked against national/regional comparators. The data, in a HIPAA-compliant non-identifying format, comprise a national aggregate database of 28.4 million isolates from 358 institutions. This database was interrogated to determine resistance rates for eleven hospitals in Puerto Rico from 1998-2003 and, as comparators, those in the database from the State of Florida and all U.S. institutions. RESULTS Between 1996-2003, data on 328,837 isolates collected from 11 hospitals throughout Puerto Rico, 5,388,897 isolates from 46 institutions in Florida, and 24,951,098 isolates from 358 U.S. institutions for the following organisms (number of antibiotics tested against) were reviewed for susceptibility: coagulase-negative staphylococci (14)/Staphylococcus epidermidis (18), Enterococcus faecalis (7), Enterococcus faecium (5), Enterococcus species (4), Escherichia coli (24), Klebsiella pneumoniae (24), Proteus mirabilis (22), Pseudomonas aeruginosa (14), Serratia marcescens (22), Staphylococcus aureus (23), and Streptococcus pneumoniae (9). Antimicrobial resistance in Puerto Rico varied organism to organism from that observed in Florida and nationally. CONCLUSIONS This first broad analysis of antimicrobial resistance in Puerto Rico provides important baseline data, both for sentinel surveillance programs and for determining strategies for intervention.